
TUTTLE 




WORLD BOOK COMPANY 













Class tf/k ft/ 

Book : 

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COPYRIGHT DEPOSIT. 



PRINCIPLES OF 
PUBLIC HEALTH 

A SIMPLE TEXT BOOK ON HYGIENE 
PRESENTING THE PRINCIPLES FUNDA- 
MENTAL TO THE CONSERVATION OF 
INDIVIDUAL AND COMMUNITY HEALTH 

By THOS. D. TUTTLE, B.S., M.D. 

SECRETARY AND EXECUTIVE OFFICER OF 
THE STATE BOARD OF HEALTH OF MONTANA 




YONKERS-ON-HUDSON, NEW YORK 

WORLD BOOK COMPANY 

1910 



&% 



CONSERVATION OF HEALTH 

" Our national health is physically our greatest asset. To 
prevent any possible deterioration of the American stock 
should be a national ambition." — Theodore Roosevelt. 



The conservation of individual and national 
health is the keynote of these books 

PRINCIPLES OF PUBLIC HEALTH 

By Thos. D. Tuttle, M.D., Secretary and Executive Officer 
of the State Board of Health of Montana. Illustrated. Cloth, 
vii + 1 86 pages. List price 50 cents, mailing price 60 cents. 

PRIMER OF HYGIENE 

By John W. Ritchie, of the College of William and Mary in 
Virginia, and Joseph S. Caldwell, of the George Peabody 
College for Teachers, Nashville, Tennessee. Illustrated. Cloth. 
vi + 184 pages. List price 40 cents, mailing price 48 cents. 

PRIMER OF SANITATION 

By John W. Ritchie. Illustrated. Cloth, vi + 200 pages. 
List price 50 cents, mailing price 60 cents. 

HUMAN PHYSIOLOGY 

By John W. Ritchie. Illustrated in black and colors. Cloth. 
vi -f 362 pages. List price 80 cents, mailing price 96 cents. 



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Copyright^ l<?lO, by World Book Company. All rights reserved 



©CI. A 2 70345 



INTRODUCTION 

The earliest history of remote ages describes methods 
employed in combating disease, and down through all the 
centuries the struggle against infection has been going on. 
The science of health as applied in recent years revfcals 
wonderful progress in the avoidance of disease, and in the 
control of the violent epidemics by which in the past na- 
tions were almost exterminated. Modern methods of hy- 
giene and sanitation as applied to public health have robbed 
smallpox and diphtheria of their death-dealing power; 
cholera and yellow fever have been forced to retreat before 
the victorious hosts of applied medical science; tuberculosis, 
the greatest foe of human life, is slowly but surely receding 
before the determined efforts of modern preventive medicine. 

By nature man is endowed with resistive power sufficient 
to ward off most forms of disease, provided he keeps his 
health at a normal standard by right living. If, however, 
he allows his health to become impaired by reason of over- 
work, bad habits, wilful exposure to contagion or unhealth- 
ful surroundings, he readily falls a prey to disease. 

The author of Principles of Public Health has here set 
forth the general rules of life by the observance of which 
every adult and every child not only can do much to pre- 
serve his own health but also can prove himself a prominent 
factor in raising the standard of public health. A campaign 
of education is demanded to arrest the enormous loss of 
life which is carrying so many to untimely graves, and the 
instruction given in this volume will be of inestimable 
value in teaching people how to avoid avoidable disease. 

The author has not attempted to deal with all the dis- 
eases that may be classed as preventable; as the work is 
intended for use in the public schools, only such diseases 
are mentioned as it seems fitting to present to school 
children. To teach our children a proper respect for their 
own health and for the community welfare is to fit them for 
the best citizenship. 

E. A. Pierce, M. D. 

Portland, Oregon 



ACKNOWLEDGMENTS 

The author wishes to express his sincere appreciation of 
the valuable assistance rendered in the preparation of this 
work by Dr. S. T. Armstrong, of New York City; Dr. H. 
Wheeler Bond, Commissioner of Health, St. Louis, Mis- 
souri; Dr. H. M. Bracken, Secretary and Executive Officer 
of the State Board of Health of Minnesota; J. S. Caldwell, 
Professor of Biology, George Peabody College for Teachers, 
Nashville, Tennessee; R. J. Condon, Superintendent of 
Schools, Providence, Rhode Island; Mrs. Nona B. Eddy, of 
the Public Schools of Helena, Montana; Dr. F. M. Mc- 
Murray, of Teachers College, Columbia University, New 
York City; Miss Jessie B. Montgomery, Supervising Critic 
in Training School, State Normal School, Terre Haute, In- 
diana; Dr. E, A. Pierce, Secretary and Executive Officer 
of the State Board of Health of Oregon. 



CONTENTS 

PART I — THE FIGHT FOR HEALTH 

CHAPTER PAGE 

I. Constant Danger of Illness i 

II. The Necessity of Caring for the Body . . 4 

III. How Clothing Affects Health 9 

IV. The Uses of Food 14 

V. Care of Food — Meats 18 

VI. Care of Food — Milk 22 

VII. Decomposition of Food 30 

VIII. Harm Done by Improper Cooking .... 34 
IX. How Neatness, Cheerfulness, and Good Man- 
ners Promote Health 37 

X. Dangers from Poor Teeth 41 

XI. Necessity for Pure Air and how to Secure it 45 

XII. Rest Essential to Health 51 

XIII. Care of the Eye and Ear 56 

XIV. Care of the Skin 60 

XV. Common Poisons to be Avoided 64 

PART II — THE ENEMIES OF HEALTH 

XVI. Disease Germs 73 

XVII. Encouragement of Disease by Uncleanly 

Habits 75 

XVIII. Flies as Carriers of Disease 79 

XIX. How Disease Germs get into Water ... 85 

XX. Transmission of Disease through the Air . 89 

XXI. Insects as Carriers of Disease 92 

XXII. How to Keep Germs out of Wounds ... 95 

v 



v [ CONTENTS 

CHAPTER PAGE 

XXIII. Transmission of Diphtheria ioo 

XXIV. The Cure of Diphtherl\ 108 

XXV. How Typhoid Fever Germs are Carried . 113 

XXVI. Hookworm Disease and Amoebic Dysentery 120 

XXVII. How Scarlet Fever is Carried . . . . 123 
XXVIII. Measles and Whooping Cough Dangerous 

Diseases 128 

XXIX. How Smallpox is Prevented 131 

XXX. Why Vaccination Sometimes seems a Failure 13S 
XXXI. Consumption, the Great White Plague . 142 
XXXII. How Consumption is Spread and how Pre- 
vented 150 

XXXIII. How Consumption is Cured 157 

Appendix — Summary of Anatomy 163 

Suggestions to the Teacher 182 

Index 1S3 



PART I 

THE FIGHT FOR HEALTH 
CHAPTER I 

CONSTANT DANGER OF ILLNESS 

Every boy and girl confidently expects to grow into a 
strong and healthy man or woman. How often we hear 
a child say, "When I am a man," or ''When I am a 
woman;" but I have never heard a boy or a girl say, "If 
I live to be a man or woman." When you think of what 
you will do when you are grown into men or women, it 
never occurs to you that you may be weak and sickly and 
therefore not able to do the very things that you would 
most like to do. This suggests that sickness is not natural, 
else the thought that you may perhaps become sick would 
enter your mind. As a matter of fact, most sickness is not 
natural. 

There is a constant struggle going on in the world. The fight for 
You see a fight about you every day among the animals. 
You see the spider catch the fly, the snake catch the 
frog, the bird catch the insect, and the big fish catch 
the minnow ; and you have heard of wars where men kill 
one another. 

The greatest enemies that men have to fight, however, 
are not other men, or wild animals, but foes that kill 
more men, women and children every year than were 
ever killed in the same length of time by war. These 
foes are small, very small, but you must not think that 



life 



2 PRINCIPLES OF PUBLIC HEALTH 

because things are small they are not dangerous. We call 
these foes disease germs. 
The nature The germ is a very, very small body ; it is the smallest 

living body that we know. Later we shall learn that our 
bodies are made up of cells, and that these cells are ex- 





Fig. i. Looking at cells Fig. 2. Some skin cells as 

through a microscope. seen through a microscope. 

tremely small — so small that it takes a very powerful 
microscope to see one of them. The germ is still smaller 
than the cells in our bodies, and it is made of a single cell. 
There are a great many kinds of germs in the world. 
Fortunately, most of them are not harmful. Some germs 
cause disease, but there are other germs that not only are 
not harmful, but are actually helpful to men. Among 
the helpful germs are those that enrich the ground, and 
these should be protected ; but all germs that cause disease 
should be destroyed as rapidly as possible. These germs 
are fighting all the time against our health. They are not 
armed with guns and cannon, neither do they build forts 
from which to fight; but they get inside our bodies and 
attack us there. 



CONSTANT DANGER OF ILLNESS 3 

There are three principal ways by which we fight How to fight 
disease germs: firsts by keeping our bodies so well and germs 
strong that germs cannot live in them; second, by keeping 
germs out of our bodies; third, by preventing germs 
from accumulating in the world — that is, by killing as 
many of them as possible. 

If it is possible to keep so well and strong that disease 
germs cannot live in our bodies, you will naturally infer 
that there are other causes of sickness besides disease 
germs. That is true, for there are a great many things 
beside germs that cause our bodies to get into such a con- 
dition that disease germs can enter and grow and make 
us ill. We sometimes call this a " run-down'' condition. 
Before we begin, then,, to study the germs that cause 
disease, we must learn how to keep our bodies strong and 
ready to right these germs. 

Questions. 1. What evidence have we that sickness is not 
natural? 2. Name some of the fights going on in the animal 
world. 3. What can you say of the amount of illness caused 
by germs? 4. Tell what you have learned about germs. 
5. Xame three ways of righting germs. 

Remember. 1. Most sickness comes from failure to observe 
Nature's laws. 2. We must keep up a constant tight against 
germs that cause sickness. 3. We light germs by killing as 
many of them as we can. and by keeping our bodies so strong 
that if a disease germ enters it cannot grow. 



How the 
body is like 
an automo- 
bile 



CHAPTER II 

THE NECESSITY OF CARING FOR THE BODY 

These bodies of ours are built somewhat like automo- 
biles. An automobile is made up of a framework, wheels, 




intestine 



Fig. 3. The organs of the body. 

body, gasoline tank, engine, and steering-gear. The 
human body has much the same form of construction. 
We have a frame, which is made of the bones of the body. 

4 



THE NECESSITY OF CARING FOR THE BODY 5 

We have arms and legs, which correspond to the wheels of 
the automobile. We have many little pockets in our bod- 
ies in which fat is stored, and these little pockets answer to 
the gasoline tank of the automobile. We have an engine 
which, like the automobile engine, is made up of many 
parts; and we have a head or brain, that plays the same 
part as the steering-gear of the automobile. 

The automobile has a tank in which is carried the gaso- 
line necessary to develop power for the machine. If the 
gasoline gives out, the engine will not run, and before 
the owner starts on a trip, he is always careful to see that 
the tank is well filled. In the same way, if we do not 
provide new fat for the pockets in our bodies in which the 
fat is stored, our supply will soon give out and our bodies 
will refuse to work, just as the engine of the automobile 
will refuse to work when the gasoline is used up. 

The automobile is made of iron and wood and rubber, what cells 
and each bit of iron and wood and rubber is made up of 
tiny particles. The body is made of bones and muscles, 
covered with skin, and all these are made up of very 
fine particles that w r e call cells. Every part of the body 
is made of these fine cells. The cells are so small that 
they can be seen only with a powerful microscope. If 
you look at your hand you cannot see a cell, because it 
takes a great many cells to make a spot large enough for 
you to see. In Figure i you see a boy looking through a 
microscope, and beside him you see a picture of what he 
sees. This picture does not look like the skin on your 
hand, neither does it look like the skin on the boy's hand; 
but it is nothing more nor less than a piece of skin taken 
from that boy's hand, and it looks just as a piece of skin 



are like 



6 PRINCIPLES OF PUBLIC HEALTH 

from your own hand would look if you were to see it 
through a very strong microscope. 
Why cells The whole body is made up of just such little cells as 

killed 110 e y° u see * n Fig ure 4> an d each cell is alive and has a 
certain work to perform. It is very important that we 
keep these cells from dying and that they perform the 
work for which they are intended, for if these cells die 
or fail to act, the body becomes sick or dies. 

You can scratch some of the paint from your auto- 
mobile and the machine will work just as well as ever. 
Apparently no harm has been done, but 
an opening has been made through which 
moisture and germs can enter and cause 
the wood to rot and the iron to rust. You 
can remove certain parts of the automobile 
and still the machine w T ill do its work ; but 
Fig 4 A cell y ou cannot take away too much of any 

(a) Cell body; one part without weakening the automo- 

(b) nucleus; (c) bile, and if certain parts are missing (such 
as the sparker, the battery, or the steering- 
gear), the usefulness of the machine is destroyed. So it 
is with the body. You can scratch off some of the skin 
and not do any apparent harm, but you have made an 
opening through which germs may get into the body. 
You can remove certain parts of the body, such as the 
arm or leg, and still the body will do efficient service. 
But there are certain parts of the body that are neces- 
sary to life, just as certain parts of the automobile are 
necessary to the usefulness of the machine. You cannot 
remove the heart and live ; you cannot remove the brain 
and live. 




THE NECESSITY OF CARING FOR THE BODY 7 

You are probably thinking that it must be easy to kill How cells 
such a little thing as a cell; and so it is. Cells can be are x 
killed by too much heat or too much cold. When you 
skin your hand, you kill many cells, and at the same time 
make an opening for germs to get in and cause sickness. 
You can kill cells also by starving them, for they must 
have not only enough food, but the right kind of food. 
If you feed your bodies on nothing but candy, pie, and 
cake, most of the cells will refuse to perform their work 
and many of them will die. These cells must have also 
an abundance of air, and the air must be pure and fresh. 
If you breathe the air that others have breathed or that 
contains poison of any kind, you will soon find that you 
are not feeling well. This simply means that so many of 
the cells are being starved for fresh air, that not enough 
strong ones are left to do the necessary work. You can 
kill these cells by overwork, for they must have a proper 
amount of rest. If you go to school all day long and then 
sit up until midnight every night, you must not expect 
the cells of your body to keep strong and well. You 
can kill these cells by the use of certain things that 
act as poisons to them, such as tobacco, beer, wine, or 
whisky. 

Questions. 1. In what way is the body like an automobile? 

2. What are cells like? 3. Why must cells not be killed? 
4. Name five ways by which we kill cells. 

Remember. 1. Each part of the body is important to the 
welfare of the whole body. 2. Each part of the body is 
made up of very small particles that we call cells; each cell 
in the body is alive and has a certain work to perform. 

3. Cells are very easily weakened and killed. 4. There are 



8 PRINCIPLES OF PUBLIC HEALTH 

five principal ways by which we kill the cells in our bodies: 
by too much heat or cold; by not giving them the proper 
kinds of foods; by not giving them enough fresh air; 
by giving them too much work to do; and by poisoning 
them. 



CHAPTER III 

HOW CLOTHING AFFECTS HEALTH 

The body should always be kept at as nearly uniform Why the 
a temperature as possible 
clothing. 



In order to do this we wear {^^J 1 * 
Clothing keeps out the heat on a hot day, just covered 




Fig. '5. Warm, dry clothing necessary for health. 

as it keeps the heat in and the cold out on a cold day. 
The clothing should be equally heavy on all parts of the 
body. It is not right to w r ear a thick dress over your 
chest and leave your shoulders and arms bare, or nearly 
so. People who do this are killing a great many cells by 

9 



IO 



PRINCIPLES OF PUBLIC HEALTH 



Why cloth- 
ing should 
not be too 
heavy 



When a 
draft is 
dangerous 



letting part of their bodies become chilled while the rest 
is warm, probably too warm. 

The clothing should be just heavy enough to keep the 
body warm. If you wear such heavy clothing indoors 
that you are constantly perspiring, your underclothes be- 
come damp, and when you go out, even though you put 
on your overcoat, your body becomes chilled. If you 
begin to sneeze, that is Nature's way of telling you that 
you are killing many of your cells by too much cold. 

People sometimes get warm from exercising, and then 
take off their coats. They should have removed their 
coats before they began to exercise. If you take off your 
coat after you are too warm, your body becomes chilled. 
Baseball pitchers know this, and if you watch a good 
pitcher, you will see that he always puts on his sweater 
as soon as he stops pitching, even though he is very 
warm. He knows that if he cools off too quickly, he will 
become stiff and sore and cannot pitch good ball. 

Sometimes a person sits in a warm room until he be- 
gins to perspire freely. Then he opens a window and sits 
in the draft. Under ordinary conditions, the cool wind 
alone would chill the body, but now the rapid drying of 
the perspiration makes the body cool still more quickly. 
The sudden chill causes the person to take cold, which is 
simply another way of saying that he has killed many cells 
and caused others to fall sick, so that they cannot perform 
their work. We cannot get too much fresh air. Drafts 
do not hurt us if we are thoroughly wrapped up ; but it is 
very dangerous to allow the wind to strike the body when 
it is not well protected, and especially when it is damp 
with perspiration. 



HOW CLOTHING AFFECTS HEALTH 



II 



Damp clothing chills the body very rapidly and kills Why damp 
many cells. Indeed, if a single one of the germs that dangerous 
cause pneumonia were to enter your 
lungs while you were wearing damp 
clothing, it would grow so rapidly 
that you might have pneumonia in 
a very little while. That is why it 
is important to change your shoes 
and stockings as soon as you get 
them wet, and to take off immedi- 
ately any clothing that becomes 
damp. It is hard for boys and girls 
to keep their feet dry in the winter 
and spring months, and rubbers are 
a nuisance; but if you expect to 
grow into the strong man or woman 
you picture yourself becoming, you 
must take care to wear your rubbers. 
Otherwise you may become weak 
and sickly, and never be able to do 
the things you hope to do. 

The feet are not the only part of 
the body that needs to be kept dry. 
A wet coat is just as harmful as 
wet shoes- and stockings; hence, 
you should always carry an um- 
brella or wear a raincoat when you go out into the rain. 
Umbrellas are unhandy for boys and girls to carry, but 
if you will remember that thousands of little cells in 
your body are being injured when you get wet and 
chilled, you will be willing to take your umbrella. 




Fig. 6. Properly pre- 
pared for wet weather. 



12 



PRINCIPLES OF PUBLIC HEALTH 



When to 
wear an 
overcoat 



In cold weather the same amount of clothing should 
not be worn in the house and outdoors; for this reason, 
we have overcoats. If you wear your overcoat in the 
house, you will become overwarm and your undercloth- 
ing will then become damp with perspiration; w T hen 




Figs. 7 and 8. If you keep your overcoat on in the house, your 
underclothes become damp from perspiration, and when you go out- 
doors your body becomes chilled. 

you go outdoors into the cold air, this dampness will have 
just the same effect as would dampness that comes from 
outside. 

As soon as the weather gets cold, put on your overcoat 
every time you go outdoors, and take it off as soon as you 
come into the house. This is troublesome for boys and 
girls to do, because they want to run in and out of the 
house so often; but on the other hand, think of all the 
cells you will kill if you do not do this, and you will cer- 
tainly consider it worth while to take off your coat and put 
it on again. 



HOW CLOTHING AFFECTS HEALTH 1 3 

Questions. 1. How does keeping the body equally covered 
protect the cells? 2. Give reasons for not wearing too heavy 
clothing. 3. When is it safe to sit in a draft, and when danger- 
ous ? 4. What is the danger of keeping on wet shoes or other 
damp clothing? 5. When and why should overcoats be worn? 

Remember. 1. Clothing should be just heavy enough to keep 
the body warm all the time. 2. Never take off your coat or 
sit in a draft when you are too warm. 3. Since wearing damp 
clothing causes a great deal of sickness, change your clothes 
as soon as they become wet or damp. 4. Do not forget to 
take your umbrella when it is raining and to wear your rubbers 
when the ground is wet. 5. In cold weather wear your over- 
coat when you are outdoors, but take it off when you come 
into the house. 



CHAPTER IV 



THE USES OF FOOD 



Why the 
body needs 
new cells 



How the 
body keeps 
itself warm 



We kill a great many of the cells in our bodies by starv- 
ing them; either we do not give them enough food or we 
do not supply the right kind of food. 

Not only must we feed the cells in our bodies, but we 
must be constantly making new ones, for in all our w T ork 
or play, awake or asleep, we are constantly using up cer- 
tain cells. These cells are used to make the body go, 
just as the engine uses coal to form the steam that gives 
it power to run. Boys and girls grow fast and, of course, 
if they expect to become well men and women, they must 
make a great many new cells all the time, in addition to 
those used in doing the work of the body. If we are to 
make new cells we must have the right kind of food with 
which to make them. 

We want to do something besides make new cells; we 
want to keep warm and well the cells we already have. 
No amount of clothing would keep you warm if you were 
not making heat inside your body all the time, any more 
than you could make a telephone post warm by putting 
your coat on it. Therefore it is necessary to have food 
that makes heat in the body, in addition to food that 
builds cells. 

We eat a great many kinds of foods, and all that we eat 
is used either for building new cells or for producing heat 
in the body. Thus we can divide all our foods into two 
classes — building material and heat-producing material. 
The type of building material is lean meat, and the type 
of heat-producing material is fat meat and starches, such 
as potatoes and bread. Milk contains much building 



14 



THE USES OF FOOD 1 5 

material as well as heat-producing material. That is 
why a baby grows and keeps warm while he takes nothing 
but milk. 

Lean meat is the best of all building foods. Eggs are The build- 
largely a form of lean meat, and hence constitute a good mg 00 s 
article of food for building purposes. Certain vegetables 
contain a large per cent of building material; this is es- 
pecially true of dried beans and peas. Wheat flour and 
corn meal (particularly when made of whole wheat and 
unbolted meal) contain much building material. 

It is possible for one to live and grow when eating only 
vegetable matter. But the boy or girl who tries to become 
a strong man or woman by eating only vegetables will be 
disappointed; these are mostly heat-producing foods and 
will not make strong bodies. Experience has proved that 
the best results are obtained by eating what is called "a 
mixed diet/' that is, a diet composed partly of lean meats 
and partly of fats and vegetables. 

Of the heat-producing foods, fat is the most powerful. The heat- 
Most of the fat that we eat is used immediately for pro- foods Cmg 
ducing in the body heat, and therefore power, but a part 
of it is stored up for future use. We see it in all healthy 
young persons. It is this stored-up fat that gives the 
body its rounded form. When any one has been sick he 
is thin, because, to produce heat and power while he was 
sick, he has had to use the fat stored up in his body. To 
have such a supply of fat is like having a bank account to 
draw on when out of work. We might call the deposits of 
fat in our bodies our health banks. 

Fat meat is not the only form in which we eat fats ; we 
eat them in a great many other ways. Certain vegetables, 



16 



PRINCIPLES OF PUBLIC HEALTH 



Cost of suit- 
able foods 



The real 
value of 
advertised 
foods 



such as beans, contain an oil that forms fat. Ripe olives 
contain a great deal of fatty oil. Butter is a very impor- 
tant form of fat. and cream contains a large amount of it. 

In selecting our foods we should think of two things; 
first) the value of the food as a heat-producer or as a build- 
ing material; and second, the cost of the food. We may 
like butter much better than bacon, but we should re- 
member that, pound for pound, bacon has a greater 
nourishing power than butter, and a pound of bacon will 
cost far Less than a pound of butter. 1 

Vegetable foods produce heat by means of the starch 
which they contain. All vegetables contain starch. This 
starch is changed into a kind of sugar in the body, and 
when thus changed it is used to produce heat and power. 
All vegetable foods do not have the same heat-producing 
power. There is more heat-producing power in a pound 
of oatmeal than there is in ten pounds of cabbage. Ten 
cents' worth of dried beans will produce more heat in the 
body than will a dollar's worth of lettuce. Thirty cents' 
worth of corn meal will do more building in the body than 
will a piece of mutton worth a dollar and a half ; but you 
would have to eat a large amount of corn meal in order 
to secure the building effect that would result from eat- 
ing a small quantity of mutton. In most fruits the only 
nourishing quality is in the sugar they contain. This 
sugar produces heat in the body just as starch does. 

You will see some foods advertised as possessing a 
wonderful nourishing power. Do not let such statements 

1 Bujar and Baier state that the nourishing power of bacon is rep- 
resented by 2,767, while the nourishing power of butter is represented 
by 2,610. 



THE USES OF FOOD 1 7 

deceive you, for no food can have a greater nourishing 
power than the things from which it is made. If the par- 
ticular food advertised is made from wheat flour, its 
nourishing power is just the same as that of an equal 
quantity of wheat flour. If it is made from corn meal, it 
can have no greater nourishing power than has the meal 
itself. 

We have learned something about the materials neces- 
sary in food and why they are needed. We must now 
learn why foods that contain these materials sometimes 
do not give us as good results as we might hope for. 

Questions, i. What use does the body make of new cells? 
2. How does the body keep itself warm? 3. Name two uses 
that the body makes of food. 4. What foods are especially 
useful for making cells? 5. What foods are chiefly used for 
making heat? 6. Select articles of food for two meals of 
equal nourishing value, one meal to be expensive and the other 
inexpensive. 7. How would you determine the real value of 
any food? 

Remember. 1. Foods are used to make heat and power in the 
body and to make the body grow. 2. The foods that make 
the body grow are called building materials, and lean meat is 
the best kind of building material. 3. The foods that produce 
heat and power in the body are called heat-producing ma- 
terials, and fats and starches are the best heat-producers. 
4. All vegetables contain starch, some of them contain a fatty 
oil, and most of them contain some building material. 5. You 
can get as much building and heat-producing material from 
cheap foods as you can from expensive foods. 



Value of 
meat as a 
food 



CHAPTER V 

CARE OF FOOD -MEATS 

Meat is one of the most important articles of our diet. 
It furnishes essential materials for building cells, and it 
furnishes fat for making heat and power in the body. 



Character- 
istics of 
good meat 



How meat 
may be 
kept clean 




Fig. 9. A double menace to health ; the slaughter- 
house is dirty, and the filth is drained into a stream. 

Since meat is so important an article of food, we should be 
very careful to see that it is handled in a way to keep it al- 
ways perfectly clean. We should make sure that it comes 
from animals absolutely free from any kind of disease, and 
that no germs have been allowed to develop poisons in it. 

While people know that they ought to pay attention to 
these things, as a matter of fact they do not do it. They 
take very little interest in the way the meat that they 
are to eat is handled, and very few ever go to the 
slaughterhouse or into the back room of the butcher 
shop to see whether things are kept clean or not. Some 

18 



C4RE OF FOOD — MEATS 



19 



people say, "Oh, we do not like to go there because it is 
such a horrid place." If these places were kept clean, 
as they should be, they would not be "horrid." And if 
the people who buy the meat would occasionally visit 
them, these places would be kept clean. 




Fig. 10. Properly displayed foods, protected from handling and 
from dirt and flies. 



If the slaughterhouse and the butcher shop where your 
meats are handled are not kept clean, the meat is sure to 
have germs growing in it, and these germs will cause 
poisons called ptomaines to form in the meat. There may 
not be enough of them to make you sick, but there will be 
enough to injure some of the cells of your body, and to 
deprive you of much of the nourishment that you would 
otherwise get from the meat. 

All boys and girls should belong to a "Clean Meat 
League" and should try to persuade their parents not to 
buy meat from any butcher who does not keep his 
slaughterhouse and butcher shop clean. 

Sometimes butchers are anxious to make money fast 
and take little thought for the number of people they may 



Dangers 
from dis- 
eased meat 



20 



PRINCIPLES OF PUBLIC HEALTH 



make ill. They can buy sick cows very much cheaper 
than well ones. The meat from a sick cow looks just like 
the meat from a healthy cow, and the dishonest butcher 
sells both at the same price. The meat from the diseased 
cow is not suitable for food. It may cause you to have the 
same disease that the cow had, or it may only be changed 



How to pre- 
vent the sale 
of diseased 
meats 




Fig." ii. Improperly displayed foods, exposed to handling and 
to dirt and flies. 

to such an extent that it will not give you the nourish- 
ment that you should get from good meat. The butcher 
who sells you meat from a sick cow is of course dishonest. 
Ask your father to visit the slaughterhouse where your 
meat is killed. The only thing you need to do is to per- 
suade him to go and see whether the cattle are sick or not. 
If the cattle look sick, you will not have to ask him not to 
buy the meat. No person should ever eat meat that comes 
from a diseased animal, no matter what the nature of the 
sickness may be. People who will take the trouble to 
visit the slaughterhouses occasionally, to investigate these 
things for themselves, will not have such meat offered 
them. 



CARE OF FOOD — MEATS 21 

Animals that are fed on filthy food are not fit for human Importance 
consumption. Butchers often feed the offal (the insides) animalsf 
of animals to the hogs. This makes the hogs fatten clean food 
quickly, but it also makes them diseased. When you go 
to the slaughterhouse with your father, ask him to go 
around to the back door, and if you see hogs eating this 
filth, do not buy any more meat from that butcher. 

Questions, i. What use does the body make of meat? 
2. What conditions are essential for good meat? 3. How can 
meat be kept clean ? 4. Why is meat from a diseased animal 
unfit for food? 5. How can you help in preventing the sale 
of meat from diseased animals? 6. Why should animals not 
be fed with offal? 

Remember. 1. Meat that is not handled in a clean manner 
is sure to contain germs that cause a poison to form in the 
meat. 2. Never buy meat from a butcher who does not keep 
his slaughterhouse and butcher shop clean. 3. Meat from a 
diseased animal is not fit for food. 4. Meat from animals 
fed on filthy food should not be eaten. 5. Form a " Clean 
Meat League" and visit the slaughterhouse where your meat 
is killed. 



Value of 
milk as a 
food 



Milk as a 
carrier of 
germs 



CHAPTER VI 

CARE OF FOOD — MILK 

Milk is another important article of food. The De- 
partment of Agriculture at Washington says that milk 
furnishes sixteen per cent of the nourishment of the 
people of this country. Milk is an excellent food when it 
is pure, but when it is not pure it is very dangerous. 




Fig. 12. A clean dairy. 

Milk has carried the germs of every disease of which 
the germ is known; it has also carried many diseases of 
which we do not know the germ. Disease germs grow 
rapidly in milk, and they do not make the milk look 
different or taste different from milk that is perfectly pure. 
If you could take two bottles of milk entirely free from 
disease germs and put typhoid fever germs in one, and 
should set both bottles in an ice box for twenty-four hours, 
you would not then be able to tell into which one you had 
put the germs. The milk in both bottles would look and 
taste just the same. The only difference between the milk 
in the two bottles would be that if you drank from one it 
would make you stronger and would furnish you with both 



CAKE OF FOOD — MILK 



23 



\,*f 



building material and power-producing material, while 
if you drank from the other you would become very ill 
and would probably die. 

Since we cannot tell from the taste or the appearance of 
milk whether or not there are disease germs in it, we must 
take every precaution possible 
to keep them out. The first 
step is to learn w T here the 
disease germs come from and 
how they get into the milk. 

Every cow has more or less 
dirt on her sides and udder; 
some have a great deal. When 
the cow is milked, much of 
the dirt falls into the milk 
bucket. This dirt always con- 
tains a great many germs of 
different kinds, and many of 
them are germs that cause disease. Straining the milk 
will take out much of the dirt, but disease germs will go 
through the finest strainer that was ever made. 

In Figure 13 we see a man milking a dirty cow. The 
owner has allowed his lot to become so dirty that the 
cow cannot find a clean place in w r hich to lie down. 
If the man kept his lot clean, and if before milk- 
ing the light dirt on the cow's sides and udder were 
wiped off with a damp cloth, no germs would fall into 
the milk. 

Another source of dirt and disease germs in milk is the 
barn. The w r alls of a barn where cows are milked should 
always be kept clean and should be whitewashed 



Fig. 13. Polluted milk is 
sure to come from a dairy 
where cleanliness is not ob- 
served. 



How dis- 
ease germs 
get into 
milk: 



(1) By dirt 
on the cow 



(2) By dirt 
in the cow 
barn 



24 



PRINCIPLES OF PUBLIC HEALTH 



frequently. If this is done, there will be comparatively 
little dirt on the walls to fall into the milk. 

Of course the walls and floors of a barn cannot be kept 
absolutely clean. There will always be some dirt, and 




Fig. 14. Only clean milk will come from a dairy where proper 
precautions are taken. 

the movements of the cows shifting their position and 
switching their tails, will stir up the dust; so it is impor- 
tant to remove the milk from the barn as soon as possible. 
Milk cans should never be kept in the barn. The milk 
should be taken directly from the barn to a cooling house 
and there strained. 

All barns where cows are kept should have plenty of 
windows, that there may be an abundance of light and fresh 
air. Cows need fresh air just as much as people do, 
while a barn that is not supplied with plenty of light is 
very likely to be a dirty barn. 



CARE OF FOOD — MILK 



25 



Keep dirt and disease germs out of the milk by keeping 
the barn clean and by taking the milk away from the barn 
as soon as possible. 

Another source of dirt and disease germs in milk is 
the milkman or milkmaid. No matter how careful we 
may be, our clothes hold more or less dust, and all dust 



[3) By dirt 
on the 
milkman 





Fig. 15. A dirty, insanitary 
milk-house. 



Fig. 16. A clean, inexpen- 
sive milk-house. 



contains germs, very often disease germs. When a person 
is milking a cow, the dust from his clothes is shaken off 
into the milk. The only way to avoid this is to wear, while 
milking, a special suit of clothes made of white cloth, 
which may be washed as soon as it shows the least 
particle of dirt. 

The milker's hands, too, are often dirty. Perhaps he 
carefully washes his hands after milking, but not before. 
It is a common custom for milkers to moisten their hands 
with milk while milking, and to do this frequently. The 
result is that dirty milk from their hands is constantly 
dropping into the milk pail. This is a very bad habit, 



26 



PRINCIPLES OF PUBLIC HEALTH 



U) By dirt 
in cans 
and bottles 



and doubly bad if the milkman has not washed his hands 
before milking. 

Sometimes there are sick people at the dairy farm. 
Often some one nurses a sick person until milking time 
and then goes out and milks the cows. When this is done, 

the milker is almost 
sure to plant the 
germs of the disease 
in the milk. No milk 
should ever be used 
from any dairy where 
there is an infectious 
disease; and no one 
who has charge of 
a sick person, no 
matter what the na- 
ture of the sickness, 
should ever handle 
milk that is to be 
used by others. 
The cans and bottles in which the milk is placed are 
frequently sources of dirt and germs. Milk cans and 
bottles are supposed to be thoroughly washed before milk 
is put into them, and they should be thoroughly scalded 
after they are washed. This is not always done, and 
sometimes the bottles are not washed at all. 

Some dairymen will tell you that the bottles and cans 
are always washed and scalded just before the milk is put 
into them, and that this is never neglected by any dairy- 
man. That is what a dairyman once told me. Then I 
asked him how he accounted for the fact that I had found 




Fig. 



i7- 



model bottling 
ment. 



establish- 



CARE OF FOOD — MILK 2J 

a milk ticket in the bottle with the fresh milk. Of course 
he could not explain this, though I thought I could ex- 
plain it for him. The old milk bottle was returned to the 
milkman with the ticket for the new milk inside it. The 
deliveryman left the fresh milk, but forgot to take the 
ticket out of the bottle; and the man who "washed" the 
bottles must have forgotten to take out the ticket too. Of 
course, the bottle was not washed at all, and if one bottle 
goes unwashed, it is reasonable to assume that others are 
neglected in the same way. 

Milk bottles and cans should always be thoroughly 
washed before fresh milk is put into them. This washing 
cannot be done by little children ; it is work for a man or 
woman, and careful work at that. 

I have just told you that milk vessels should be thor- (5) By pol- 
oughly washed. It is true, however, that disease germs 
may get into the milk through this very process of wash- 
ing the vessels. Water sometimes contains disease germs, 
especially the germs that cause typhoid fever, cholera, 
and other diseases of the intestines. Such water is said 
to be polluted. When milk vessels are washed with 
polluted ■ water, the germs are left in them and thus get 
into the milk. If the water used to wash the cans is 
thoroughly boiled, the germs .will be killed ; hence it is 
important to scald all milk vessels. 

All water used about a dairy should be perfectly pure. 
If there is the least suspicion about the quality of the 
water, it should be examined by a chemist; and if it is 
not pure, the milk from such a dairy should not be used. 
In order to prevent the possibility of any infection, all 
water used to wash milk vessels should be thoroughly 



luted water 



28 PRINCIPLES OF PUBLIC HEALTH 

' boiled even when the water is known to be pure, and 
the vessels should afterward be scalded, to kill any germs 
that may be left after washing. 

(6) By flies Flies very frequently get into the milk. Later we shall 
the milk ° learn more about how flies carry germs, but at present it 

is enough to know that on every fly there are a great 
many germs, and whenever a fly gets into milk it plants 
those germs and they grow very rapidly. As soon as a 
cow is milked, the milk should be taken to a clean cool- 
ing house, with screens at all the windows and doors, 
and there strained into a vessel and cooled. 

(7) By dis- The last way that we will mention by which germs get 

63.SG in thfi 

cow into milk is by disease in the cow herself. Cows suffer 

from many diseases, just as men do; and when a cow is 
sick, her milk is very likely to contain the germs of the 
disease that is making her sick. Especially is this true of 
tuberculosis, or consumption, as it is called. A great 
many children get consumption by drinking milk from 
consumptive cows. No milk should ever be used from a 
cow that is not healthy. All dairy cows should be ex- 
amined at frequent intervals by a competent veterinarian 
to make sure that they are free from any disease. 

Questions, i. Milk forms what per cent of the food of the 
people of the United States? *2. Why is it important that milk 
should be kept clean ? 3. Name some ways by which germs get 
into milk. 4. What is the danger from a dirty cow and barn ? 
5. How can this danger be prevented? 6. How does the 
milkman allow germs to get into the milk, and how can he 
avoid doing so? 7. How should milk cans and bottles be 
washed? 8. Why is it important that only pure water be used 
about the dairy? 9. How can flies be kept out of milk? 
10. How should milch cows be tested to make sure that they 
are free from tuberculosis? 



CARE OF FOOD — MILK 29 

Remember. 1. Milk is a very important article of food; it 
is both a building and a heat-producing material. 2. When 
milk is not properly handled, it contains many disease germs. 
3. Disease germs often get into milk from unwashed bottles 
and cans; from dirty barns; from dirty milkmen; from dirty 
water used to wash the cans and bottles; from flies falling 
into the milk; from diseased cows. 



CHAPTER VII 



DECOMPOSITION OF FOOD 



Why parti- 
ally decom- 
posed foods 
should not 
be eaten 



What causes 
decomposi- 
tion 




Vegetables and fruits that are partially decayed should 
not be eaten. Even if an orange is decayed only on one 
side, the products of decomposition — that is, the poisons 
produced by decay — have extended all 
through the orange. You cannot see them, 
but they are there. It is the same with a 
decaying apple, potato, or melon. It never 
pays to buy partially decayed or stale fruits 
or vegetables, for not only are they dan- 
gerous to health, but they are so reduced 
in nourishing qualities by decomposition 
that you get little value for the money you 
Fig. 18. Par- spend. It is always better economy to 
tially decayed b fresh fruitg and ve g eta bles, or even 
fruit is not fit J \ f t , , ! 

for food. canned vegetables, when the latter are 

properly put up. 
All decomposition (rotting) in fruits and vegetables is 
due to the action of germs. If you will look at a bunch 
of old grapes, you will notice that some of the grapes are 
rotten, while others have dried up. Now, if you examine 
them very carefully, you will find that all the decomposed 
grapes have breaks in the skin. The break may be very 
small, but it is there, and through this break the germs 
that cause decomposition have entered. You will find 
also that there is not the slightest break in the skin of any 
grape that has dried up. The germs could not enter, 
hence there has been no decomposition. It is the same 
with other fruits and vegetables : if the germs that cause 
decomposition cannot get inside, the fruit or vegetable 
will dry up, but will not rot. 

30 



DECOMPOSITION OF FOOD 



31 




Germs can go through a very small opening — so small 
that you may not be able to find it ; but if there is decom- 
position, the hole is there. 

The skin of the body acts 
in the same way as the skin 
of the grape and keeps out 
a great many germs that 
would make us sick were 
they able to get through the 
skin. They often get 
through the skin when we 
cut ourselves. 

Meats decompose as well Fig. 19. Fruits displayed for 
as fruits and vegetables, sale, but properly protected from 

j 4.1 j -4.- ■ flies, dust, and dirty hands, 

and the decomposition is ' ' J 

due to the presence of germs 
in the meat. We cannot 
keep all germs out of meat, 
but we can keep out a great 
many of them by having 
everything clean about the 
meat, by keeping it covered 
as much of the time as 
possible, and by handling it 
only with clean hands. 

When meat is kept so 
cold that it is almost frozen, 




Fig. 20. Fruits for sale, not 
properly protected from flies, 
dirt, and other sources of filth. 



Why foods 
do not de- 
compose in 



the germs cannot grow, and ver y cold 

places 

decomposition is prevented. 



In this way meat can be kept perfectly free from decom- 
position for several weeks. After the meat is taken from 



32 



PRINCIPLES OF PUBLIC HEALTH 



What is 
formed in 
food by de- 
composition 



Why some 
canned 
meats are 
poisonous 



the cold storage room, it should be cut as soon as possible 
into steaks, roasts, and other pieces for cooking; and 
when taken to your home, it should be kept in an ice box 
until the time to cook it. You cannot keep meat very long 
at home without decomposition starting, because small 
ice boxes are not cold enough to check entirely the growth 
of germs. 

Unless the meat is to be eaten hot, it should be cooled 
after cooking and placed again in the ice box as soon 
as possible. Cooking kills the germs that are in the 
meat before it is cooked; but unless it is kept in a 
very cold place and protected from flies after it is 
cooked, germs will get into it again as soon as it is cold. 
Cooked meat will decompose just the same as uncooked 
meat. 

When germs are allowed to grow in meat, as always 
happens when it is not kept in a very cold place, these 
germs cause the poisons that we call ptomaines. The peo- 
ple who eat such meat become sick, and in many cases 
do not recover. Cooking meat that contains ptomaines 
will kill the germs that caused the poison, but it will not 
destroy the poison that has already been formed. 

People not infrequently are poisoned by eating canned 
meat. Sometimes you will hear it said that the poison 
formed because the meat was in cans. This is not true; 
the cans had nothing to do with the forming of the poison. 
This was caused by germs that were allowed to grow in 
the meat before it was cooked. When the meat was cooked 
the germs were killed, but the poison was not destroyed. 
In other words, the poison developed before the meat was 
canned, and not after it was put into the cans. 



DECOMPOSITION OF FOOD 33 

Questions, i. What is the objection to eating fruits when 
they are partially decayed? 2. Why do some foods shrivel 
while others decay? 3. Why does decomposition not go on 
in cold places? 4. What are ptomaines? 5. When are 
ptomaines formed in canned meats? 

Remember. 1. Partially decomposed fruits or vegetables are 
not suitable for foods. 2. Meats in which germs have been 
allowed to grow should not be eaten. 3. Cooking meat kills 
the germs in it, but does not destroy the poisons that the germs 
have formed. 4. When canned meats are poisonous, it is 
because the poison was formed before the meat was canned; 
the poison is not caused by the can. 



Effects of 
improper 
cooking 



Why starchy 
foods should 
be thorough- 
ly cooked 



How fats 
should be 
cooked 



CHAPTER VIII 

HARM DONE BY IMPROPER COOKING 

Nearly all food should be cooked before it is eaten; 
but if the cooking is not properly done, much of the 
nourishing power of the food is destroyed, and in some 
instances the food is rendered actually injurious. 

Starchy foods should be thoroughly cooked in order 
that the coverings which surround the little granules may 
be broken or made soft. If starchy foods are not thor- 
oughly cooked, the little grains go into the stomach as 
hard as grains of sand ; then most of them are not digested 
at all, but pass out of the system without furnishing any 
nourishment to the body. If starchy foods are fried in 
fats, as is the case w T ith doughnuts, the granules of starch 
become coated with fat. As the fat is not digested until 
it comes to the intestines, the saliva never reaches the cover- 
ings of the starch, and more work is thrown on the other 
juices of the body. The result is that the little glands 
which make these other juices are overworked, or else the 
starch is not digested at all and therefore furnishes no 
nourishment to the body. When bread is sticky (we 
sometimes call it soggy) in the middle of the loaf, it is 
because the flour has not been thoroughly cooked and the 
little grains or granules of starch are still hard. You can- 
not feel these granules between your fingers, but they are 
hard just the same, and very little of such food is made 
use of in the body. 

Remember that all starchy foods should be thoroughly 
cooked, and remember, too, that all vegetables are chiefly 
starchy in character. 

When fats are cooked over a very hot fire, an acid is 
developed that is injurious to the body. This does not 

34 



HARM DONE BY IMPROPER COOKING 35 

mean that when the fire is hot enough to broil a steak 
well, it causes this acid to form; neither does it mean that 
heat sufficient to boil the grease for cooking doughnuts 
will cause it to form. Every cook knows that when she 
fries fat meat over a fire that is too hot, it has a bitter 
taste. This bitter taste is caused by an acid which will 
destroy a part of the usefulness of the food in the body 
and will cause many of the cells to stop doing their work 
properly. 

There is a great difference of opinion in regard to cook- How meats 
ing foods, especially meats. Some people will tell you cooked * 
that meats should not be cooked at all; that man origin- 
ally ate his meat raw and that this is the proper way. 
Others will tell you that all meat should be cooked until 
it does not show a particle of red, even until it is dry 
throughout. These are the two extremes; and it is never 
well to go to extremes in anything, especially in matters 
that concern the health. 

Meat should always be cooked, because by being cooked 
it is made more easily digestible; but it should not be 
cooked, until all the juices, which contain much of the 
nourishing matter, are dried up and the meat made 
hard. Meat that is cooked until it is dry and hard is 
more difficult to digest than meat that is not cooked 
at all. 

Questions, i. What effect has improper cooking on foods? 
2. Why should starches be thoroughly cooked? 3. What is 
the objection to starchy foods fried in grease? 4. What 
changes take place in fatty food when it is fried over a very 
hot fire? 5. Why should all meats be cooked? 6. What is 
the objection to cooking meat until the juices are dried out? 



36 PRINCIPLES OF PUBLIC HEALTH 

Remember, i. Starchy foods should be thoroughly cooked so 
that the fine grains may be softened and the food thus made 
more easy to digest. 2. Fats should not be fried over a very 
hot fire because too much heat causes a poison to form in the 
fat. 3. Meats should be cooked, but never until they become 
dry, as the juices in the meat contain most of the nourishing 
material. 



CHAPTER IX 

HOW NEATNESS, CHEERFULNESS, AND GOOD MANNERS 
PROMOTE HEALTH 

The dining table should be the pleasantest and most why meal- 
inviting place in the house. If you are complaining and ^Dl^ant 
quarreling during the meal, you cannot enjoy the food; 
you cannot eat it properly; and your ill temper will so 




Fig. 21. A clean, inviting dining-room. 

affect your body that you cannot properly digest what 
you eat. A dirty table, with flies swarming over the food, 
is not very tempting, and when seated at such a table, 
one does not eat the things that are best for him and 
sometimes does not eat anything at all. 

The luncheons that boys and girls take to school with How uninvit- 
them are often prepared in so careless a way that they are ^cms^ffect 
extremely uninviting. The substantial school lunch can be the appetite 
made just as appetizing as the dainty refreshments at an 
afternoon tea or at a party. If the same care is devoted to 

37 



38 



PRINCIPLES OF PUBLIC HEALTH 



Why an at- 
tractive table 
calls for 
pleasing 
guests 



How foods 
should be 
eaten 



the preparation of the one as of the other, boys and girls 
will eat their lunches with enjoyment and good appetites. 

If the table is made to look clean and inviting, do you 
not think that you, in your turn, should make yourself 
as neat and clean as possible before you come to it ? Dirt 




Fig. 22. Two lunches. Which is the more tempting? 

on your hands and face not only does not look well, but 
contains a great many germs that may get into your food 
and thus find their w T ay into your body and try to make 
you ill. 

Besides being eaten in pleasant surroundings, all food 
should be eaten slowly. Let us suppose that we are all 
seated at a clean, inviting table and everyone is clean and 
happy. Before the children is the very kind of food that 
is best for them. It looks good and they know it is good, 
and they want to eat all they can of it. But they think of 
a game of jacks or of ball that they want to play as soon 
as dinner is over, so they simply "bolt" their food. 

What are teeth made for? Why, to chew with, of 
course. But why are we given some teeth that are sharp 
like knives, and some that are flat like millstones? It 



HOW GOOD MANNERS PROMOTE HEALTH yj 

seems probable that these different kinds of teeth are in- 
tended for special purposes, and so they are. If our teeth 
were intended only for cutting our food into bits small 
enough to swallow without causing pain, there would be 
no need for any except the sharp, knife-like teeth. But 
we have the big grinders, which were made to use, and it 
is very important that they be used in the right way. 

We do not chew our food simply to make it fine Why food 
enough to swallow, but for quite another reason as well, thoroughly 
In our mouths there is a fluid called saliva. Think of chewed 
something that you are very fond of eating, and the mere 
thought of it makes the saliva come into your mouth. 
This saliva has a very important duty to perform in con- 
nection with preparing the food for the little cells of the 
body. Each little grain of starch — and you will remember 
that all vegetable foods are composed largely of starch — 
has a capsule about it. This simply means that it is done 
up in a little package. The saliva helps to open this 
capsule by making it soft (just as water will soften the 
paper on a package of candy), so that the other digestive 
juices can reach the starch and turn it into the kind of 
sugar that is used in the body. If you do not chew your 
food very fine, the saliva will not reach the starch granules, 
the little packages of starch will be hard to open w T hen 
they go into the stomach, and much of the starch will 
never be made use of in the body. The saliva has much 
the same action on the coverings of the little packages of 
meat, for all the meat that we eat is done up in similar 
packages. 

A great Englishman, Mr. Gladstone, who lived to be 
eighty-three, made a practice of chewing every bite of 



40 PRINCIPLES OF PUBLIC HEALTH 

food twenty times, and he thought this had a great deal 
to do with his being such a strong and well man and living 
to such an old age. 
When des- After you have eaten meats, bread, and vegetables, it 
not harmful w ^ do no harm to eat a piece of pie or cake, or a dish of 
ice-cream or some other dessert. It is not easy, as a rule, 
to digest these things (that is, to get them into such shape 
that they can be used as food by the little cells in the body) , 
but a moderate amount of them is very good for boys and 
girls, as well as for grown people. If you refuse to eat the 
meat and bread, but wait until the dessert is served and 
then fill your stomach with sweet things, you will be 
starving some of the little cells, and you will be reminded 
of this very soon. Sometimes you may be reminded of 
it by having a pain in your stomach, but more often by 
getting low grades in your lessons at school. Your teacher 
will know it, too, because you will be so restless and in- 
attentive in your classes that she will have to give you a 
low grade in deportment as well. 

Questions, i. What kind of topics should be discussed at 
mealtime? 2. What is the objection to an untidy table? 
3. What kind of luncheon do you like best? 4. What does a 
clean table call for? 5. What is the importance of eating 
slowly? 6. Why should we chew our food thoroughly? 
7. When are desserts not harmful? 

Remember. 1. The dining table should be the most inviting 
place in the house. 2. Unpleasant subjects should be avoided 
at mealtime. 3. A clean table calls for clean people. 4. Eat 
slowly and chew your food thoroughly, that the saliva may 
reach each grain of starch. 5. Desserts are not harmful if 
eaten at the end of a meal composed of good building and 
heat-producing materials. 



CHAPTER X 

DANGERS FROM POOR TEETH 

We have learned that chewing is not merely a process 
of cutting our food into such lumps as we can swallow 
without hurting ourselves; but that the food must be 
ground up fine and thoroughly mixed with the saliva, that 
the saliva may reach every particle of starch. If we do not 
have good teeth, we cannot grind our food as fine as it 
ought to be ground, and, as a result, a great deal of the 
starch will not be reached by the saliva. 

Nature starts every child with a full set of good, strong, 
clean teeth. These teeth, which we call first, or milk, teeth, 
are not very large, but they are perfect in every respect and 
last until the second, or permanent, teeth come in. That 
is, they will last so long if they are taken care of. If they 
are not taken care of, they will decay just as the later teeth 
will decay, and they must be cared for in the same way. 

Boys and girls sometimes wonder why they have a set Why we 
of teeth that come out before they can have the teeth that r milk 
must last them the rest of their lives. This is simply teeth 
because there is not room enough in a child's mouth for 
the big, permanent teeth. We must have teeth while our 
jaws are growing, so we have first a set of little teeth. 
Then just as soon as our jaws get large enough for the big 
teeth, the little teeth come out and the big ones come in. 

Teeth are about the hardest substance in the body. If 
we take care of our second teeth, they should last as long 
as we live. The only reason they do not last is because we 
do not take care of them. If a person would keep his 
teeth clean all the time, he would rarely be obliged to have 
a single permanent tooth pulled. 

41 



42 



PRINCIPLES OF PUBLIC HEALTH 



Why teeth 
break easily 



Why teeth 
decay 




Fig. 23. Teeth were not in 
tended for nutcrackers. 



Teeth are so hard that they are brittle, that is, they 
break easily. Glass is brittle, and you can chip off a piece 
of glass with a pin by sticking the pin into a crack in the 
glass. In just the same way you can chip off a piece of a 
tooth by sticking a pin between two teeth. That is what 

often happens when people 
pick their teeth with pins, or 
with any other hard substance. 
A metal toothpick is just as 
bad as a pin. 

Another way by which little 
pieces are chipped off the 
teeth is by biting hard things. 
Sometimes we see boys and 
girls cracking nuts with their teeth ; again we see them try- 
ing to bite wires in two. They put their teeth to many uses 
for which teeth were never made. They do not realize, 
while they are abusing their teeth in this way, that they 
are probably chipping the enamel, which is the hard, shiny 
covering of the tooth, and are destroying the one protec- 
tion that their teeth have against decay. 

When a little piece is chipped off a tooth, an opening is 
made through the enamel. Through this opening germs 
may lodge in the inner part of the tooth, which is soft. 
When this happens, a little black speck appears on the 
tooth, and after a while the tooth begins to ache. If you 
have a toothache, you go to a dentist, and he probably 
finds that germs have caused the tooth to decay until 
there is a hole extending into the very center of it. 

Teeth grow very close together, but there is always a 
little space between them. Whenever you eat anything, 



DANGERS FROM POOR TEETH 



43 



-=J 








-1 




— 02 


jp 


t : -"JP^I 


— 




S" .* 


f 










".. 


1 


I : 








9 urnim 



particles of the food get into these spaces and if allowed 
to remain there, soon decompose. These decomposing 
particles of food between the teeth will gradually soften 
even the enamel, and in this way little openings are made 
for germs to get into the teeth. 

Never pick the teeth. You cannot make them clean 
by picking them. Every 
morning and night brush 
your teeth with a stiff 
toothbrush and a little 
tooth powder. Brush them 
both crosswise and up and 
down, to get out everything 
from between them. Do 
not think you have done 

your duty if you brush only FlG - 2 4- A sanitary wash-basin 
your front teeth, the ones 
that show. Brush the back 
teeth just as thoroughly as you do the front teeth. Very 
few people will see your back teeth, but these decay just 
as fast as your front teeth, if they are not kept clean. 

Twice each year you should have a dentist examine 
your teeth, to see if there are any little spots where decay 
has started. If you have kept your teeth perfectly clean 
all the time, and have not chipped off little pieces, there 
will be none of these decayed spots. But it is a safe plan to 
have the teeth looked over at least twice a year, for you may 
have broken a tooth without knowing it, and by the time 
a decayed spot is large enough to cause pain, or has made 
a hole that you can feel with your tongue, it has advanced 
much farther than it should have been permitted to do. 



with a separate bowl for washing 
the teeth. 



How to care 
for the 
teeth 



How often 
one should 
go to the 
dentist 



44 PRINCIPLES OF PUBLIC HEALTH 

Questions, i. Why should you chew your food thoroughly? 
2. Why is it necessary to have baby teeth? 3. How are teeth 
easily broken? 4. Why do teeth decay? 5. What must you 
avoid in order to protect your teeth? 6. How should your 
teeth be brushed? 7. Why should you have your teeth ex- 
amined twice each year by a dentist? 

Remember. 1. Take care of your teeth and they will last 
you as long as you live. 2. Do not pick them with pins, or 
toothpicks of any kind. 3. Do not use them for nutcrackers 
or wire-cutters. 4. Do not use them for tack pullers. 5. Keep 
them clean at all times. 6. Brush them up and down as well 
as crosswise. 



CHAPTER XI 

NECESSITY FOR PURE AIR AND HOW TO SECURE IT 

We have learned how the cells of the body are killed by 
starvation. Now let us learn how they are choked to death, 
or killed by lack of air. 

The cells of the body need oxygen, and the only way we How air is 
can give it to them is by means of air. Every time we take ^e^ody"* 
air into our lungs we are giving oxygen to the red cor- 
puscles or cells in the blood, which distribute it to the other 
cells in the body. The air that goes into our lungs, if it is 
fresh and pure, contains a great deal of oxygen and a very 
little of another gas called carbon dioxid. The air that 
comes out of the lungs contains a very little oxygen and a 
great deal of carbon dioxid. The blood not only takes the 
oxygen out of the air, but gives carbon dioxid to the air. 
This carbon dioxid is very poisonous, and would kill the 
cells if it remained in the blood; hence we should never 
breathe the same air twice. There is no lack of fresh air 
in the world, and no excuse for anyone's ever breathing air 
that is not pure. 

If you. close all the windows and doors in the schoolroom Effects of 
and shut up the ventilators, you will soon find that you are un P ure air 
not able to pay close attention to your studies, and in a 
little while you will begin to feel drowsy. This is because 
you have used up so much of the oxygen in the air that 
there is no longer enough to supply the demands of the little 
cells, and because, in addition, you are taking into your 
bodies the poisonous carbon dioxid that has been breathed 
out into the room. It takes a great deal of fresh air to 
supply the body with oxygen — about 1,250 cubic feet of air 
each hour. With thirty or forty children in a room, it does 

45 



4 6 



PRINCIPLES OF PUBLIC HEALTH 



Methods 
of ventila- 
tion 



not take long to use up all the oxygen. So there should 
be a constant supply of fresh air coming into the room. 

It is not only in the schoolroom that you need oxygen. 
When you are out-of-doors you get an abundance of fresh 

air, but from a great many 
houses every bit of fresh air 
is shut out. It is always 
possible to let an abun- 
dance of fresh air into any 
house without causing a 
draft. A piece of board can 
be made to fit into a win- 
dow frame so that when the 
window is raised, the air will 
be directed upward and will 
not cause a draft. Hot-air 
furnaces are made with cold- 
air pipes. The fresh air from 
outdoors comes through 




Fig. 



25. Results of breathing 
good and bad air. 



these cold-air pipes and, after being heated, is driven into 
the rooms of the house. Some people think they will save 
coal by closing these drafts. Not only do they not save 
coal ( for the furnace does not give as much heat when this 
draft is closed ) , but they kill their body cells by refusing to 
give them oxygen. The cold-air pipe in a hot-air furnace 
should always be kept wide open. 

In houses heated with steam or hot water, either the win- 
dows must be kept open, or some other way must be pro- 
vided for admitting fresh air and taking out foul air. These 
arrangements constitute a system of ventilation. Houses 
heated with stoves must also be provided with some means 



PURE AIR AND HOW TO SECURE IT 47 

of ventilation. The stove, by its draft, takes out a little 
of the foul air, but it will not take out more air than one 
person poisons. 

Many people seem to think that they do not need fresh Why win- 
air at night, and they close their bedroom windows as tight be kept open 

at night 




Fig. 26. Restfulness: Effect of Fig. 27. Restlessness: Effect of 
good ventilation in a sleeping- poor ventilation in a sleeping- 
room, with the right position for room, with the wrong position for 
sleeping. sleeping. 

as they can. Those people do not sleep well and often 
have bad colds. You should always sleep with your win- 
dows open. If it is impossible for you to have your win- 
dows open without having a draft, choose the draft; it 
will do you no harm if you are well covered, and under no 
circumstances will it do you as much harm as the foul air 
that you breathe if your window is closed. Some persons 
(fortunately they are few nowadays) will tell you that night 
air is dangerous. I wonder what kind of air these people 
expect to breathe at night. Do they expect to fill the room 



4 8 



PRINCIPLES OF PUBLIC HEALTH 



The ven- 
tilation of 
public as- 
sembly 
rooms 



Ventila- 
tion of 
workshops 



Why we 
should 
breathe 
through 
the nose 



in the daytime with enough air for use at night ? Such air 
would certainly not be very fresh. Night air is the only 
kind of air that it is possible to breathe at night. 

Churches, theaters, and ten-cent shows are often very 
poorly ventilated. You can always tell a poorly ventilated 
room by the foul odor when you go into it from the fresh 
air, and it is not wise to stay in such a room. You are 
killing the cells in your body when you do so, and you will 
very probably come out of it with a bad cold. When the 
fresh air strikes you, you feel chilly and you may think you 
are taking cold then, but in reality you took cold in that 
room full of foul air. 

Workshops are often poorly ventilated. No person 
should ever work in a badly ventilated place. The labor 
unions frequently strike for higher wages, but until recently 
a strike for better ventilation was rarely heard of. Better 
ventilation would be practically equal to an increase in 
wages, because there would be fewer doctors' bills to pay, 
and less likelihood of losing work through illness. Always 
have plenty of pure, fresh air wherever you are — in school, 
in bed, at work, or at play. 

The cells in the skin of the nose secrete a watery fluid, 
and this fluid serves to moisten the air as it passes through 
the nose. Dry air irritates the mucous membrane which 
lines the nose, throat, and lungs, and it is very important 
that the air be moistened before it reaches the throat. Air 
is also warmed as it passes through the nose. Cold air is 
irritating to the throat and lungs. The small hairs in the 
nose catch the dust and dirt in the air and prevent it from 
going into the lungs. 

The nose was made to breathe through, and all the air 



PURE AIR AND HOW TO SECURE IT 



49 



that goes into your lungs should pass through your nose, in 
order that it may be moistened, warmed, and cleansed. 

Frequently we see boys and girls breathing through the Why some 
mouth. They do this because there is something in the ^reatiie 1 ' 

South 




Fig. 28. Showing position of adenoids and tonsils in the throat. 

nose that prevents the air from passing freely through it. 
If there were nothing in the way, the child would breathe 
through the nose instead of the mouth, because the natural 
way of breathing is through the nose. 

The most common reason for mouth-breathing is the 
growth of small lumps in the throat just behind the nose. 
These little lumps are called adenoids. They are not 
natural, and should be taken out. We do not know why 
they grow in some children and not in others, but we do 
know that they should be taken out so that the child can 
breathe easily through the nose. Large tonsils also cause 



50 PRINCIPLES OF PUBLIC HEALTH 

boys and girls to breathe through the mouth. Tonsils that 
are large enough to cause the child to breathe through the 
mouth ought always to be taken out. Large tonsils and 
adenoids are often found in the same child. 
Effects of When a child breathes through his mouth all the time, 

breathing *^ s ^ ace ta kes on a peculiar shape. His upper lip grows 
long, his lower jaw drops back, and his whole face looks 
flat. His voice has a peculiar sound, and he finds it very 
hard to keep up in his classes at school. Children with 
adenoids and large tonsils are always backward in their 
school work, and may become deaf if the adenoids and 
tonsils are not removed. 

If you breathe through your mouth instead of through 
the nose, go to the doctor and let him see if you have ade- 
noids or large tonsils ; if you have, let him take them out. 
You cannot possibly grow into a strong, healthy man or 
woman if you have adenoids and do not have them removed. 

Questions, i. What does the body take out of the air? 
2. What does the body put into the air? 3. What effect does 
impure air have on the body ? 4. Why should one sleep with 
windows open? 5. What causes the unpleasant odor in a 
crowded room? 6. How would workmen benefit by properly 
ventilated workshops? 7. Name the helpful ways in which 
the air is changed while passing through the nose. 8. Why do 
some children breathe through the mouth? 9. What effect 
comes from mouth-breathing? 

Remember. 1. Impure air destroys health. 2. Never sleep 
in a room where the window is closed. 3. Avoid going into 
public places or workshops that are not well ventilated. 4. Air 
must pass through the nose before it is fit for the lungs. 
5. Mouth-breathing is not natural and is usually due to some 
defect that can easily be cured. 



CHAPTER XII 

REST ESSENTIAL TO HEALTH 

Exercise is necessary to make our bodies grow and be- Why exer- 
come strong. If we stayed in bed all the time, our muscles necessary 
would not grow and we could not even walk. If we did 
not exercise them, the cells in our brains would not grow 
and we should not know anything. Every part of our 
body must have exercise, that is, each part must do some 
work every day. If we used only one part of the body and 
did not give the other parts any work to do, only the 
part that we used would grow, while all the rest of the 
body would be small and weak. 

While every part should do some work each day, the Proportion 

whole body needs also to have a proper amount of rest. re quired 

Even the heart, which seems to be working all the time, 

must rest. It rests between each beat. The muscles with 

which we breathe rest between each breath. Every person 

must have a certain amount of rest each day. A man should 

have at least eight hours ' sleep in every twenty-four hours ; 

boys and girls should have from nine to ten hours' sleep in 

every twenty-four. It is only while w T e are sleeping that we 

have complete rest. 

Everybody should have some w T ork to do. Boys and Effect of 

overwork 
girls should learn that work is a part of life, though 

they should not be expected to do too much. They 

should not be required to get up at four o'clock in 

the morning and work until eight, then go to school 

until four in the afternoon, and then work again until 

dark. They cannot do this and keep well. Such 

children will surely neglect their lessons and will fail 

to keep up in their classes. It is not the children's 

51 



52 



PRINCIPLES OF PUBLIC HEALTH 



Ways in 
which chil- 
dren over- 
work then- 
bodies 



fault, but the fault of the people who give them so 
much to do outside of school. 

Sometimes bright children fall behind in their classes 
and seem to be sleepy during school hours. Very often 
these children do not have to do any work at home, but 
play all the time they are out of school. We usually find 




Fig. 29. Children work when they play. The little girl skipping 
rope is killing the body cells by overwork; she has skipped more 
than one hundred times and is exhausted. 

that these children not only play all the afternoon, but also 
go to parties at night and often stay up until midnight. 

You may think it is not work to go to a party, but it really 
is. You are working the muscles and the cells of your 
brain when you are playing games, and these get tired 
from play work just as they do from working. It is more 
fun to do play work than to do real work, but the cells are 
tired and need rest after either kind of exercise. When you 
go to a party and stay up until midnight, you do not get nine 
hours of sleep. How do you expect the cells of your bodies 
to get enough rest when you treat them in this way? 



REST ESSENTIAL TO HEALTH 53 

Another thing you do at parties is to eat food that 
tastes good, but which is not good building material or 
nourishing for the cells of the body. These things eaten 
late at night stay in your stomach long after you have 
gone to bed, and the cells of your stomach do not have a 
chance to rest at all. 

Children should have their parties in the afternoon. 
You can have just as much fun at a party in the afternoon 
as you can at night, and then your stomach will have time to 
dispose of the cake and candies you have eaten, and will be 
ready to rest when you go to bed. 

Small children should be in bed by eight o'clock at 
night, and even big girls and boys should be asleep by ten 
o'clock every night. If you do not give your bodies rest, 
you can never grow into strong men and women. 

We have learned that every part of the body needs reg- The im- 
ular rest. Your stomach is a part of your body. In the regular 6 ° 
stomach and intestines all the food is changed so that the meals 
little cells can make use of it. Do you think the cook would 
serve good meals if she were kept cooking all the time, 
both night and day ? You know she would soon stop cook- 
ing for you if you did not give her time to rest. Your 
stomach does work that is even more important to you 
than cooking. 

It takes about four hours for your stomach to dispose Why meals 
of what you give it at a single meal. If you eat your break- at j east 
fast at eight o'clock, your stomach is going to be kept busy four hours 
to get rid of it by noon. Of course you expect to give it 
more work to do at noon ; that is, you expect to eat a good 
luncheon. It will be after. four o'clock by the time your 
stomach has finished the task you put on it at noon, and 



54 



PRINCIPLES OF PUBLIC HEALTH 



When and 
why candy 
eating is 
harmful 



When candy 
eating is 
not harm- 
ful 



there will be only about an hour and a half for the stomach 
to rest before you will be ready to give it another four hours' 
task, digesting your supper. This means that your stomach 
cannot go to sleep until ten o'clock. If you eat three meals 
a day, you will give your stomach just about two hours' 
rest between eight in the morning and ten at night. If you 
let it rest from ten at night until eight in the morning, it 
is not likely to give you any trouble. 

Some people will not let their stomachs rest at all. Often 
boys and girls give their stomachs extra work to do by eat- 
ing sweetmeats in the middle of the morning w T hile their 
stomachs are still busy w T ith breakfast. Then, as soon 
as school is out in the afternoon, they want to eat more cake 
and candy, and thus take away from the stomach the little 
rest it has a right to expect before it goes to work on supper. 
Then suppose they go to a party and eat again about mid- 
night. How much time will the stomach have to rest before 
breakfast ? 

Now, I have not said that boys and girls must not eat 
candy; and what is more, I am not going to say any such 
thing. You may go home and tell your mother that candy 
is good for girls and boys and that they like it so well they 
ought to have it — no, not all the time. Here is the part 
that some of you will not like. Girls and boys ought to 
have all they want just after eating luncheon or dinner. 
If you have eaten a hearty meal, it is entirely safe for you 
to eat candy then ; you wall not be giving extra work to your 
stomach, for the candy will be taken care of along with the 
rest of the meal. 

Questions, i. Why should we all take exercise? 2. How 
much rest is needed each day? 3. Name some of the effects 



REST ESSENTIAL TO HEALTH 55 

of overwork. 4. How do children overwork their bodies? 

5. Why should children have their parties in the afternoon? 

6. Why should meal hours be regular? 7. When and why is 
candy eating harmful ? 8. When is candy eating not harmful ? 

Remember. 1. Proper rest is necessary to health. 2. Rest 
from play is as necessary as rest from work. 3. You must give 
the stomach rest by having regular meal hours and by eating 
nothing between meals. 



CHAPTER XIII 

CARE OF THE EYE AND EAR 

The loss of Sight is one of the greatest blessings we have. Think 

how dreadful it is to be blind. If you take care of your 
eyes, there is no reason why you should be blind; but if 
you do not take care of your eyes, there is a possibility that 



How germs 
get into 
the eyes 





Figs. 30 and 31. The roller towel is a common source of infec- 
tion of eyes in schools; every school should have properly con- 
structed wash-rooms, with individual towels. 

you may lose your sight. Most of the blind people in the 
world became blind because their eyes were not given 
proper care, and most of this lack of care happened when 
these people were babies. 

Many of the diseases that affect the eyes are catching. 
They are not carried through the air, but are transmitted 
by the use of a towel or handkerchief used by someone 
who had the disease. Never use the towel or handkerchief 
that another has used. 

Germs may be rubbed into the eyes. Keep your hands 
away from your eyes. Your hands may have disease germs 
on them, and when you rub your eyes you may put the 
disease germs into them. 

56 



CARE OF THE EYE AND EAR 



57 



Many boys and girls ruin their eyes by making them do 
too much work. They do this by reading in a poor light, by 
reading where the light strikes into the eyes, or by reading 
in a bad position, as when in bed or lying down. When 
you are reading, drawing, or doing any work with the eyes, 




Figs. 32 and 33. Correct positions for reading and writing. 



always have the best light possible, which means that the 
light should fall on your book or work over your left shoul- 
der. If you are only reading, it does not make much dif- 
ference which shoulder the light comes over, provided it 
comes from behind. If you are writing or drawing, and 
the light comes over your right shoulder, it makes the 
shadow of your hand fall just where you want to see. 
Another way of working your eves too much is bv try- 
ing to see when the eyes are not focused right. Sometimes 
people are said to be near-sighted, because they cannot 
see very well at a distance. This is due to the fact that the 



How eyes 
are over- 
worked 



58 



PRINCIPLES OF PUBLIC HEALTH 



Method of 
testing 
the eyes 



How to 
test the 
hearing 



How to 
care for 
the ears 



eyeball is too long, so that the lens does not cause the rays 
of light to focus on the retina. Some people are called far- 
sighted. This means that they can see well at a distance, 
but that it is hard for them to see things close to them. 
Far-sighted children can usually see things near by, but 
they do this by making the muscle that rules the lens of 
the eye work too hard. 

Probably your teacher has a test chart and can tell you 
whether your eyes are properly focused. If your eyes are 
not focused right, that is, if you cannot see the line of 
letters marked 20 when you are twenty feet from this 
chart, there is something wrong with your eyes. In that 
case, you are not only injuring them by trying to study, 
but you are hurting the whole body by overworking a part 
of it. If you cannot see the letters on the test card clearly 
at a distance of twenty feet, ask your father to send you 
to a specialist who will fit you with the proper glasses or 
will treat your eyes so that you can see well. 

Sometimes children are backward in their school work 
because they cannot hear well. Your teacher can test 
your hearing by holding a watch near your ear. If you 
cannot hear a w T atch tick when it is held six feet from your 
ear, ask your father to take you to your doctor, that he may 
treat your ears. 

If your hearing is perfect, the best way to take care of 
the ears is to let them alone. Never try to dig into the canal 
that leads to the middle ear. The ears must of course be 
washed to keep them clean, but in washing the ear you 
should not touch the delicate canal leading to the drum. 
A great specialist once said, " Never put anything smaller 
than your elbow into your ear," to which another great 



CARE OF THE EYE AND EAR 59 

specialist added, " And wrap a towel around your elbow." 
Never try to dig the wax out of your ears ; it belongs in your 
ears; it is there for a purpose, so let it alone. If it becomes 
hardened, you cannot get it out and will only injure your 
ears in trying to do so. An ear spoon is a dangerous thing. 

Questions. 1. State the chief cause of loss of sight. 2. How 
can you keep germs out of your eyes? 3. Name three ways 
by which you may overwork the eyes. 4. Tell how to take 
care of the ears. 

Remember. 1. Overworking the eyes is as injurious as over- 
working the stomach. 2. Keep your hands away from your 
eyes; germs on your hands may get into your eyes and cause 
them to become sore. 3. You overwork your eyes when you 
try to read or write in a poor light or in a bad position, as when 
lying down. 4. You overwork your eyes when you try to study 
with eyes that are not properly focused. 5. Keep your fingers 
out of your ears. 6. Take care of your ears by letting them 
alone. 



CHAPTER XIV 



CARE OF THE SKIN 



The work 
of the 
sweat 
glands 



Importance 
of bathing 



If you break or cut the skin on your body, you make an 
opening through which germs can get in. You cannot 
always help breaking your skin, but you can always wash 

the break with soap and 
water, and put a clean cloth 
over it to keep out germs. 

The work of the little sweat 
glands is very important to 
your health. These glands 
are just as important as the 
kidneys, and if they did not 
do their work, you would die 
very quickly. If your body is 
covered with dirt, the work of 
these glands is seriously in- 
terfered with; and when the 
sweat glands are not doing 
their full amount of work, the 
kidneys must do more than their share. It is never right 
to make one part of your body do the work intended for 
another part. 

When the body is dirty, not only are the sweat glands 
interfered with, but the little sebaceous (oil) glands become 
plugged up, and blackheads appear on the face and 
body. 

In order that the various glands of the skin may be kept 
in good health, it is necessary for us to keep clean. To 
do this we wash our faces and hands and bathe our bodies. 
Someone may ask, "How often ought a person to take a 

60 




Fig. 34. A model bathroom. 



CARE OF THE SKIN 



6l 





bath?" The question cannot be answered, except to say, 
" Just as often as may be necessary for you to keep abso- 
lutely clean." Some people do not have to bathe as often 
as others, but no one can keep clean unless he takes a bath 
at least twice a week. 

Another question that is frequently asked is, "Is it 
better to take a bath in cold or hot water?" This is an- 
other question that cannot be 
answered in the same way for 
every person. A cold bath is 
more stimulating than a warm 
bath. If, after you have taken 
a cold bath and rubbed your- 
self briskly with a rough towel, 
the skin becomes red and warm, 
a cold bath is best for you. 
But if, after you have taken a 
cold bath and rubbed yourself for not more than ten min- 
utes, the skin appears bluish and cold, a cold bath is not 
good for you, and you should not take it. A cold bath 
should always be taken in the morning, just after getting 
out of bed, and a warm bath should always be taken in the 
evening, just before going to bed. 

The finger nails and toe nails are a part of the skin and 
they also need to be taken care of. You will see at the 
root of your finger nails a thin layer of skin that is inclined 
to grow out with the nail. If this skin is not kept pushed 
back it becomes rough, breaks into little shreds, and forms 
"hang nails." This little band of skin should always be 
kept carefully pushed back. The finger nails should be 
kept evenly and neatly trimmed, but they should not be 



Fig. 35. A nail properly 
cared for, and a nail not 
properly cared for. Which 
should you prefer to have? 



Hot or 
cold baths 



How to 
care for 
the nails 



62 PRINCIPLES OF PUBLIC HEALTH 

cut so close to the skin that the ends of the fingers project be- 
yond the nails. The nails are for the protection of the ends 
of the fingers and toes. Nails that are trimmed unevenly 
and nails that are bitten off are ugly and indicate untidy 
habits. The shape of the nails should follow the outline of 
the ends of the finger. Neither is it a sensible fashion 
to trim the nails to points or to let them grow very long. 

The toe nails need attention just as much as do the finger 
nails. They should be trimmed to follow the shape of the 
toe. Failure to trim the toe nails properly will result in 
ingrowing nails. 

Dirt is very likely to collect under the nails. This should 
always be carefully cleaned out. You cannot wash this 
dirt out unless you use a stiff nail brush. If you clean your 
nails just after you wash your hands, you will find that it 
will be much easier to get the dirt out while the dirt and 
the nail are both softened by the soap and water. In 
cleaning your nails, use a dull nail cleaner or a smooth 
wooden stick. Do not scrape the inside of the nail with a 
sharp knife. This scraping of the inside of the nails will 
cause them to catch the dirt more easily, as well as to grow 
thicker and thicker until they become very ugly. Neat, 
clean finger nails help to make pretty hands ; dirty, untidy 
nails spoil the prettiest hands. 

Questions, i. What are the uses of the sweat glands? 
2. How often should people take baths? 3. How can you tell 
whether a hot or a cold bath is better for you ? 4. Tell how 
finger nails should be cared for. 5. How should toe nails be 
treated ? 

Remember. 1. If you do not keep your body clean, the glands 
of the skin cannot do their work properly. 2. Every person 



CARE OF THE SKIN 63 

should take a bath at least twice a week; some persons need 
a bath every day in order to keep clean. 3. If you take a bath 
in cold water, and the skin does not become warm and pink 
when you rub it with a rough towel, a cold bath is not good 
for you. 4. Cold baths should be taken in the morning on 
getting up. 5. Warm baths should be taken in the evening 
before going to bed. 6. Finger nails should always be kept 
clean and neat; dirty, untidy nails make ugly hands. 



CHAPTER XV 



COMMON POISONS TO BE AVOIDED 



Proof that 
tobacco is 
a poison 



The extra 
work caused 
by tobacco 



Many people are killing the cells of their bodies by 
taking certain poisons into them. There are many kinds 
of poisons that can be taken into the body, but we are going 

to learn now about only two. 
These are tobacco and alcohol. 
Tobacco is a poison. Those 
of you who have tried to smoke 
know4:his, because it made you 
sick the first time you tried it. 
There are many other indica- 
tions that tobacco is a poison. 
^We know that it affects the red 
, blood cells in such a way that 
they do not carry the oxygen 
as well as do those of people 
who do not smoke. We know 
that it has a very bad effect on 
the heart and that it interferes 
with the action of the nervous system. 

When certain poisons get into the body, the blood makes 
something that will counteract the effects of those poisons. 
After one has used tobacco for some time, the cells of 
the body will take care of the tobacco poison by making an 
antidote for it. More than this, they begin to want it all 
the time. The tobacco user forces the cells of his body 
to make an antidote for this poison every time he 
uses tobacco. Thus he makes the cells do work that 
is unnecessary, and keeps them from doing work that 
is necessary. 

6 4 




Effect of cigarette 
smoking. 



COMMON POISONS TO BE AVOIDED 6$ 

Tobacco smoke irritates the cells that line the throat and Other bad 

effects of 

nose and causes inflammation. This is why so many tobacco: 

smokers have catarrh. Smoking is not the only cause of ^ ° n ? e 

° J nose and 

catarrh, for people who do not smoke often have this throat 
trouble, but it is one of the most frequent causes. Smoking 




Fig. 37. The athlete knows that alcohol and tobacco are foes to 
speed, strength, and nervous control. (From photograph of u The 
Sprinter" modelled by Dr. R. Tait McKenzie.) 

also irritates the throat so badly that many of those who 
smoke have " smoker's throat." This is a bad form of sore 
throat that can be cured only by stopping the use of tobacco. 

People who smoke a great deal have fewer red corpus- (2) On the 
cles (the little red cells of the blood) than those w 7 ho do 
not smoke. Especially is this true of cigarette smokers. 
It is the lack of red blood cells that causes the cigarette 
smoker to look pale and sallow. 

It is probably not the direct effect of tobacco that 
causes the loss of red blood cells, but something that is 
connected with the act of smoking. When you take smoke 
into your mouth, you take in at the same time a gas known 



66 



PRINCIPLES OF PUBLIC HEALTH 



(3) On the 

nervous 

system 



(4) On the 
stomach 



(5) On the 
heart 



as carbon monoxid. This gas is very poisonous to the 
body, and combines with the red blood cells in such a way 
that they cannot take up the oxygen in the lungs and carry 
it to the rest of the cells in the body. The cigarette smoker 
almost always inhales the smoke, and thus he absorbs a 
great deal more of the carbon monoxid than the man who 
does not inhale the smoke. Of course, the more of this 
gas he takes into his body, the more red blood cells will be 
affected and the less oxygen will be taken to the other cells. 

We do not know just how tobacco affects the cells of 
the nervous system. It may be that they are affected mostly 
by being deprived of oxygen, or it may be that the tobacco 
affects them directly. However the harm is done, we know 
that the cells of the nervous system are affected by tobacco. 
One of the nerves that is most commonly affected by the 
use of tobacco is the nerve of the eye, the nerve that en- 
ables us to see. We know that when people use tobacco a 
great deal they sometimes lose their sight. This does not 
happen to everyone who uses tobacco, but you can never 
tell whom it will affect in this way. The only safe thing to 
do is not to use tobacco, and then you will know that you 
will not lose your sight from this cause. 

The use of tobacco affects the stomach. People who use 
tobacco a great deal are likely to have indigestion. The 
tobacco causes this probably by depriving the stomach 
cells of oxygen through its effect on the blood cells. 

Tobacco has a very bad effect on the heart. People 
who use much tobacco have what they call " palpitation of 
the heart," but doctors call it " tobacco heart," because it 
is caused by the use of tobacco. No insurance company 
will insure a person who has " tobacco heart." 



COMMON POISONS TO BE A VOIDED 67 

Most boys grow up to be men before they manage to use 
enough tobacco to cause tobacco heart. However, long 
before they are grown, they show that the tobacco has af- 
fected their hearts, because they are short of breath and 
stand about as much chance of winning a race as does a 
mouth-breather. 

The effect of alcohol is a subject on which I want to Effects of 
speak very plainly and frankly, because I do not want the 
boys and girls who read this to get the same idea that I got 
when I was in school, or to be affected by it as I w r as. When 
I was a little boy I was taught that if a person drank alcohol 
in any form the lining of his stomach would be eaten up. In 
proof of this statement I was shown a picture of an ulcerated 
stomach that was said to have resulted from drinking 
whisky. Naturally I expected to find that people who 
drank whisky would not be able to eat anything at all, or 
would be troubled a great deal with pain in their stomachs. 
To my surprise, I found that many people had ulcers of 
the stomach who never took an alcoholic drink, while many 
of those who drank a great deal seemed to have the best 
of appetites and w r ere never troubled with their stomachs. 
As a result, I came to the conclusion that all this talk about 
the evil effects of alcohol was foolishness. Later I studied 
medicine, and learned that the effect of alcohol on the 
stomach is, in reality, the least of its evils. But I want to 
impress upon you that, as a result of forty years' study, I 
consider alcohol the most dangerous thing in the world 
to-day. By " alcohol" we mean any drink that contains 
alcohol, such as whisky, w r ine, brandy, beer, etc. 

When alcohol is taken into the stomach, it first causes U) 0n the 
a congestion ; that is, it causes an increase in the quantity 



68 PRINCIPLES OF PUBLIC HEALTH 

of blood in the blood vessels of the stomach. It might 
seem that this would aid digestion in the stomach, but it 
does not, because alcohol affects the food in the stomach 
in such a way that it prevents the gastric juice from acting 
on the food. If the use of alcohol is persisted in, it causes 
the little cells in the stomach that make the gastric juice 
to become filled with fat, and then those cells cannot make 
the gastric juice. Thus, continued use of alcohol causes a 
smaller supply of gastric juice, and the food passes from 
the stomach into the intestines without having been acted 
upon by the gastric juice, as it should have been. The 
result is that the food decomposes in the intestines and 
a poison is formed. This poison is taken up by the vessels 
that carry the food from the intestines and kills a great 
many of the cells of the body. 

Alcohol does not burn holes in the stomach, but it de- 
stroys the usefulness of the stomach by its action on the 
cells that secrete the gastric juice. 

[2) On the When alcohol is taken into the stomach, very little of it 

reaches the intestines. It is rapidly absorbed by the lining 
of the stomach and passes into the blood. The blood 
from the stomach goes directly to the liver. The alcohol 
makes the cells of the liver hard and causes them to become 
filled with fat, as it does the cells of the stomach. In this 
way it destroys the action of these cells and prevents their 
doing the work for which they are intended. From the 
liver the alcohol goes with the blood to all parts of the body, 
and it has its influence on all the cells in the body. This 

(3) On the influence is always harmful. 

body's We know that when a man who is in the habit of drinking 

resistance § ets pneumonia, he is far more likely to die than is one 



COMMON POISONS TO BE A VOIDED 69 

who is not in the habit of using alcoholic drinks. The 
man who drinks cannot resist the effects of disease as 
can one who does not drink. This shows that the use of 
alcohol reduces our resisting powers, and puts our cells 
in such condition that we cannot overcome the effects of 
disease. 

People who are sick with a slow disease like consump- 
tion are often advised by their friends to take whisky to 
brace them up. It is true that the immediate effect of the 
whisky is to make the patient feel a little better, but the 
final effect is to leave him in a much weaker condition 
than before. More than this, the cells are much less able 
to resist the disease germs than they were before the alco- 
hol was taken. When people are exposed to such diseases 
as scarlet fever and smallpox, they may think that if they 
take a drink of whisky they will not be so liable to con- 
tract the disease. It is just the other way. The alcohol 
reduces the resisting powers of the cells of the body, and 
anything that does this renders a person more liable to 
contract any disease to which he is exposed. 

The effect of alcohol on the cells of the nervous system (4) On the 
is very marked. Continued use will injure the nervous system* 
system and result in a kind of insanity called delirium 
tremens, It will also cause other forms of insanity. The 
effect of alcohol on the parent is passed on to the children 
of the next generation, and even beyond this. A large 
percentage of idiotic children are the offspring of alcoholic 
parents. 

The use of alcohol numbs the sense of right and wrong. (5) On the 
More young men have become criminals from the use of 
alcohol than from any other one cause. Anyone who reads 



morals 



;o 



PRINCIPLES OF PUBLIC HEALTH 



{6) On brain 
work 



the daily papers can see that many criminals give the use 
of alcohol as an excuse for having committed a crime. 

Some people will tell you that alcohol stimulates the 
brain, so that one can work faster and better. This is not 
true. Tests have been made in this matter, and it has been 
found that men doing mental work will work about one 




Fig. 38. The mind not clouded 
by alcohol works quickly and 
makes few mistakes. 



Fig. 39. The mind clouded 
by alcohol works slowly and 
makes many mistakes. 



What busi- 
ness men 
think of 
men who 
drink 



tenth slower and make one fourth more mistakes when 
given one drink of whisky a day, than they will when not 
given any whisky. If one drink of whisky a day thus re- 
duces a man's power and accuracy in doing mental work, 
what do you think three drinks, or ten drinks will do ? 

Many business men drink, and they know the results of 
alcohol not only from the effects they have observed in 
others, but also from the effect they know it to have on 
themselves. When a man applies to them for a position, 
these business men almost invariably ask him if he drinks. 



COMMON POISONS TO BE AVOIDED J I 

The man who docs not drink stands nine chances in ten of 
securing the position, while the man who drinks stands 
only one chance in ten. This shows what business men 
think of the effect of alcohol, even when taken in moderate 
quantities. They know that it reduces a man's power to 
do mental as well as physical work, that it causes him to 
make mistakes, and that it may finally destroy his morals 
and result in his becoming a thief or a criminal. 

Questions, i. How do we know that tobacco is a poison? 

2. How does tobacco make extra work for the body ? 3. What 
effect does tobacco have on the nose and throat? 4. What is 
the effect of tobacco on the blood ? 5. On the nervous system ? 
6. On the heart? 7. Mention some of the false ideas about the 
effect of alcohol. 8. How does alcohol affect the stomach? 
9. The liver? 10. In what ways does alcohol reduce the re- 
sisting powers of the body? 11. How does alcohol affect the 
nervous system? 12. How does it influence mental work? 
13. What do business men think of drinkers? 14. What in- 
fluence has alcohol on the next generation? 

Remember. 1. Tobacco is a poison that has a very bad effect 
on the nervous system, the blood, the heart, the stomach, the 
nose, and the throat. 2. Alcohol is a poison and not a food. 

3. Alcohol injures the stomach, the liver, and the nervous 
system. 4. Alcohol reduces the power to do accurate mental 
work. 5. Alcohol numbs the sense of right and wrong, and 
encourages crime. 



PART II 

THE ENEMIES OF HEALTH 
CHAPTER XVI 

DISEASE GERMS 

We have learned that the body is made up of cells, and 
that each cell is alive. The cells in our bodies cannot live 
separately. There are, however, certain animals and plants 
that are each made up of a single cell. These animals and 
plants are called germs, and some of them cause disease. 

These germs are so exceedingly small that we can see Different 
them only with the aid of a microscope. They differ ^^ e ^ nse 
in appearance one from another, as a pine tree differs diseases 
from an ash, or an American child from a Chinese child. 
When you plant your garden, you put sweet peas in one 
place and asters in another, and you know that you will 
have sweet peas growing where you planted the pea seeds, 
and asters growing where the aster seeds were put. So 
it is with these little germs ; you will no more get tubercu- 
losis from typhoid fever germs than you would get asters 
from pea seeds. 

Now, while there are many, many kinds of germs in the 
world, there are only certain ones that cause certain dis- 
eases, and we have learned where these germs like to live 
and how to kill them. We also know that they come only 
from some person or animal sick with the particular dis- 
ease which they cause. Typhoid fever germs are not given 
off by a person suffering with tuberculosis, nor are diph- 
theria germs given off by a typhoid fever patient, but the 

73 



74 PRINCIPLES OF PUBLIC HEALTH 

germ of each disease is given off by some person or animal 

suffering from that particular disease. 

How sick- If we kill all the germs that come from people sick with a 

ness due certain disease, no one else can catch that disease. Know- 
to germs ... 
can be ing this, it seems unnecessary for anyone ever to be sick with 

preven e ^ disease that is caused by a germ. This is literally true, 

and the only reason that we have germ diseases is because 

we do not kill the germs that come from the sick people. 

Professor Irving Fisher of Yale University has said, "It 
is entirely possible to wipe out consumption within a 
single generation." It may not actually be done so 
quickly, but it is certain that the disease can finally be 
wiped out, though it may require many generations to 
accomplish it. 

Why, then, are germ diseases allowed to exist ? Simply 
because so many people do not know the facts; and 
because many who do know will not take the trouble to 
kill the germs, even when they realize that some one else 
may get the disease as a result of their carelessness. What 
do you think of a woman who said, "I do not care if my 
neighbor's children do get scarlet fever from us; she is not 
a friend of mine, any way"? A woman has been heard 
to make such a statement to a health officer. It is just such 
people as this who spread disease. 

Questions, i. How may germs be compared to seeds? 
2. What do we know about disease germs that will help us to 
get rid of them? 3. How is it possible for us to get rid of con- 
sumption and other germ diseases? 

Remember. 1. While there are many kinds of germs in the 
world, only a few cause disease. 2. The germ that causes a 
certain disease will cause that disease and no other. 3. It is 
entirely possible to kill all the germs that cause disease. 



CHAPTER XVII 



ENCOURAGEMENT OF DISEASE BY UNCLEANLY HABITS 




Why we 
should stay 
away from 
the sick- 
room 



We shall not try to learn here all the ways by which it 
is possible to destroy the germs of disease as they come 
from sick people. But there are certain rules (we some- 
times call them funda- 
mental principles) that 
you must know, if you 
hope to keep well and 
to prevent others from 
getting sick. 

The first of these rules 
is: Do not go into the 
room where any one is sick 
unless it is absolutely nec- 
essary. No one but the 
nurse should sleep in the 
room with a sick person. 
We know that certain dis- 
eases are communicable 
(catching), but it has not yet been determined whether 
some others are communicable or not. It has not been 
proved, for instance, that we cannot catch rheumatism from 
another person. Only a few years ago it was believed that 
one could not take consumption from another person, but 
now we know that this is the very way to get it. There- 
fore, stay away from sick people as much as possible. It is 
not good for the patient to have people around him, and it 
is dangerous for the well to come in contact with the sick. 

The second rule is: Do not use anything used by a sick Not using 

things used 
person until it has been washed. This is a good rule to by the sick 

75 



Fig. 40. How diseases are fre- 
quently transmitted to children. 



7 6 



PRINCIPLES OF PUBLIC HEALTH 



Reason for 
scalding 
things used 
by the sick 



How ex- 
creta from 
the sick 
should be 
treated 



Necessity 
of washing 
the hands 
after touch- 
ing the sick 



apply to things used by a well person also. It is neither 
safe nor pleasanc to eat from the spoon or fork, or to use 
the napkin or towel which has been used by someone else. 

Sometimes children think the food prepared for a sick 
person is ever so much nicer than that set before themselves, 
and wish they could have a little of it. How often have 
we seen a sick mother give her little ones "a taste" from 
the spoon with which she is eating. This is very danger- 
ous, and if she knew it, the mother would cut her hand off 
before exposing her children to this danger. 

Third : Everything taken from a sickroom should be 
boiled before it is used again. The knives, forks, and plates 
should not be put with other dishes until after they have 
been separately washed and boiled. Tow r els, napkins, bed- 
ding, and clothing from a sickroom should not be w r ashed 
with other bedding and clothing, but should be washed 
and boiled separately. Some people send out the clothes 
from the sickroom with the rest of their washing, and in 
this way give disease to others. 

Fourth: All discharges {sputum, urine , bowel discharges , 
and matter from sores) from any sick person should be 
thoroughly disinfected before being finally disposed of. The 
sputum should be received on little rags or paper napkins, 
and burned ; and the other discharges should be disinfected 
with some poison that will kill the germs. We shall say 
more about disinfection when we come to study the pre- 
vention of special diseases. 

Fifth : Every person who touches a sick person, or han- 
dles anything that comes from a sickroom, should immedi- 
ately wash his hands. Unless he washes his hands at once, 
the germs which may be on them may get into his mouth. 



DISEASE BY UNCLEANLY HABITS 



77 



Sixth : Dirt, which is an indirect cause of disease, must not How dirt 
be allowed to accumulate. If your yard were full of dirt, gar- c £^ s 
bage, and manure, it would not cause disease unless the 
germs of some disease became planted there. But such a 
place is an indirect cause of disease, in that it furnishes a 




Fig. 41. A place that is an indirect cause of disease, since it 
furnishes a fine place for germs to grow in. 

fine place for germs to grow in. If a fly with typhoid germs 
on its feet were to alight in such a yard, the germs would be 
planted in a most favorable spot and would grow very fast. 
None of the disease germs like sunshine; neither do 
they like dry places. They die very quickly in the sun- 
light, and grow very slowly, if at all, in dry places; but in 
damp, dark places they grow very fast. Dirty back yards 
make ideal gardens for germs. 



78 PRINCIPLES OF PUBLIC HEALTH 

Let a fly with germs on its feet alight in a clean yard 
where sunshine can reach every corner, and what chance 
will the germs have to grow? They will not even get a 
start. Hence, while disease cannot be caused by dirt, 
disease germs' stand a very good chance of living where 
there is plenty of dirt and no sunshine. Filthy habits are 
on an equality with filthy conditions, and go hand in hand 
with them. One of the worst of habits, and a cause of 
much sickness, is that of answering Nature's calls in places 
other than the closet. 

Questions, i. Why should you never make unnecessary 
visits to a sick person? 2. Why should you avoid anything 
used by a sick person? 3. Why should everything taken from 
a sickroom be scalded? 4. What should be done with all 
discharges from a sick person? 5. How is dirt a source of 
disease ? 

Remember. 1. Unless it is necessary, do not go into a room 
where anyone is sick. 2. Never sleep in a room with a sick 
person. 3. Never eat from a spoon or plate that has been used 
by another. 4. Boil all the articles taken from the room of a 
sick person. 5. Always wash your hands after touching a sick 
person or anything that comes from his room. 6. Sunshine 
kills germs ; let the sunshine into every corner of your house. 



CHAPTER XVIII 

FLIES AS CARRIERS OF DISEASE 

Disease germs get into our bodies in three principal How germs 
ways: they are eaten with our food; they are taken in with our bodies 
the air we breathe ; and they get in through breaks in our 
skin, even though these breaks be very small, as when made 
by the bite of a mosquito or other insect. 

How do germs get into our food or drink ? You must How germs 
remember that these germs are extremely small, so small Q^rfood- 
that many of them can be carried by a particle of dust that 
you can see only in a ray of sunshine. When the germs {1) From 
become dried, they float about on these particles of dust, 
the dust alights on our food, which is moist and warm, and 
the germs immediately begin to grow. 

Another way by which germs get on food is from the (#) From 

hands through which it passes. Did you ever think how 

many people handle an apple? First, the man who picks 

it from the tree; then the examiner in the packing house 

where apples are taken to see that they are the right kind 

to be packed in a certain box. Then it is wiped off by a boy 

or girl — handling number three ; then it is wrapped in 

paper — number four. Next it is packed in a box, but in 

this case the paper protects the apple from dirty hands. 

When the merchant buys the apples he feels several 

of them, and puts them out on the display shelf; 

this makes handling number five. Everyone who thinks 

of buying apples will touch one or more of them, 

and when they are sold the clerk handles them again. 

In other words, every apple goes through the hands of 

at least seven people before you get it. Do you not 

think it needs washing? 

79 



the hands 



8o 



PRINCIPLES OF PUBLIC HEALTH 



(3) From 
flies 



Breeding 
places of 
flies 



The journey 
of the fly 




Go into a butcher shop and see how many people 
will put their dirty fingers on the meat. Some of 
them even keep their gloves on when they do this. 
Imagine how many germs may be planted on the finger of 
a glove. 

Our whole method of displaying foods for sale is wrong. 
The customer can see the fruits, vegetables, and meats just 
as well in a glass case as when they are 
on an open counter or shelf, and noth- 
ing is gained by poking a dirty finger 
into a piece of beef, or by rubbing your 
hands over the apples. A glass case 
not only will protect the fruits and 
meats from such practices, but will 
keep out germ-laden dust and flies 
whose feet are covered with germs. 
Probably the most common source of 
germs on food is the fly. Did you ever watch a fly very 
closely for a long time? Did you ever happen to see a 
manure pile early in the morning and notice how many 
tiny flies are on it? These flies have just been hatched. 
Flies like manure because it is the best place they can find 
in which to lay their eggs. Each female fly lays about three 
hundred eggs. They do not hatch directly into flies, as 
hen's eggs hatch into chickens, but when the fly's eggs hatch 
you find maggots, and these maggots later hatch into flies. 
Turn over the manure some spring morning, and you 
will see it full of white specks. These specks are maggots 
that w T ill hatch into flies. Watch the flies as they leave the 
manure pile and see where they go. If there is a dead dog 
or cat or a filthy garbage can near, they will fly to it. Then 



Fig. 42. The foot 
of a fly, highly mag- 
nified. 



FLIES AS CARRIERS OF DISEASE 8 1 

they will go into the water-closet and crawl over the filth 
there. Their next trip will probably bring them to the 
kitchen, where they will crawl over the food. From here 
they will go to the cuspidor and take a drink of water, and 
will get their feet covered with the dirt that is in the cus- 
pidor. Next they will try a walk over the nipple of the 
baby's bottle, or they will light 
on your face, or get into the 
butter or milk. 

After the fly has been in dirty 
places, he " washes" his face and 
hands, that is, he rubs his feet 
together and then rubs them 
over his head. Did you ever see 
a fly wash himself with water? 
No, you never did. Fi g. 43- Where a fly has 

After a fly has made his walked; each little spot repre- 
journey, you would suppose that sent * a S rowth of S erms left 
his feet would be covered with 

dirt and germs, and so they are. Not only does he carry 
germs on his feet and body but he also eats dirty and 
diseased things. Moreover, fly specks contain the germs 
of disease, and the fly is not at all particular about where 
he puts his specks. 

If you let a fly walk over a culture plate, there will be a fae°i X \s\ 
grow T th of germs wherever his feet touch. A culture plate germ carrier 
is simply a glass plate covered with gelatine or something 
else in w r hich these germs like to grow, and where they can 
easily be seen. Each germ will multiply so fast that there 
will soon be a spot of them large enough to be seen readily 
with the naked eye. In the picture showing a culture plate 




82 



PRINCIPLES OF PUBLIC HEALTH 



How to get 
rid of the 
fly: 



(1) By re- 
moval of 
manure 



over which a fly has walked (Fig. 43), the 
little specks are not single germs, but each 
speck represents a growth containing many 
thousands of germs. 

How are we going to get rid of flies ? We 
cannot get rid of them entirely, but there 
are a great many ways by which we can 
prevent there being so many of them, and 
whereby we may keep them out of our 
houses and away from our food. 

We have learned that flies are always 
found about horse manure, because it 
makes a good place in which to hatch their 
eggs. If we could dispose of the manure, 
there would be one place less for the fly to 
lay her eggs. Behind barns we usually find 
piles of manure. It is in these heaps that 
the fly lays her eggs, not in the little lumps 
found in the streets. Now, there is no 
sense in keeping this great pile of manure 
about any barn. In towns the manure can 
be put into a box with a cover, so that the 
flies cannot get at it. In the country every 
well-managed farm has the barns cleaned 
out every day, and it would not be much 
more trouble for the farmer to throw the 
manure into a wagon and take it to the 
fields with him, than it is to pile it up be- 
side his barn. If he did this, he would find 
that there would be few flies about his 
house. 



Fig. 44. Flies 
go from filth to 
food. 



FLIES AS CARRIERS OF DISEASE 83 

Even if we were to take every particle of manure away [$) By cover- 
as fast as possible, we should still have some flies, for when ^| ;arbage 
flies do not find manure for their hatching places, they will 
take the next best thing. It must be something dirty ; clean 
things will not answer at all for a fly's home. Next to the 
manure pile, the fly likes a dirty garbage can, a dead animal, 
or anything that is decomposing. If she cannot find any- 
thing better, she will take a rotting apple ; but she does not 
really like this, and if she cannot find anything better than 
an old apple in your yard, she will probably go elsewhere 
to lay her eggs. 

We cannot entirely stop the hatching of flies, but if we [S) By keep- 
will do away with the old manure piles, keep fresh manure ™^g ean 
and garbage cans covered, and keep our yards free from 
everything that can decompose, we shall have very few 
flies about our houses. 

Since we cannot get rid of all the flies, the next best How to 
thing is to keep the few that may be left out of our houses k ®® oftiie 
and away from our food. This we can do by means of wire house 
screens and netting. Wire screens are very cheap, and if 
there are no w T ire screens on your house, you should per- 
suade your father to buy some. But a screen will not keep 
flies out unless it is kept closed, so do your part by never 
leaving the screen door open for a second longer than is 
necessary for you to go in or out. 

Our houses are not the only places that need 
screens. Slaughterhouses, butcher shops, candy stores, 
grocery stores — every place where any kind of food is 
handled or sold — should be screened. Flies should 
never be allowed to alight on anything which is to be 
eaten. 



84 PRINCIPLES OF PUBLIC HEALTH 

Questions, i. Name three ways by which germs get into 
our bodies. 2. How do germs get into our food? 3. Why 
should foods be screened? 4. Trace the fly from his birth- 
place to our food. 5. How do we know that flies have germs 
on their feet? 6. Tell how we can get rid of most of the 
flies. 7. How can we keep flies out of the house? 8. What 
can boys and girls do to help keep them out ? 

Remember. 1. Always wash an apple, pear, or any other 
fruit before you eat it. 2. All foods are handled by many people, 
and are not clean until they have been washed. 3. Flies like 
to live in dirty places, and their feet and legs are covered with 
germs ; get rid of the flies. 4. Flies hatch in manure piles and 
other dirty places ; keep your yard and lot clean so that flies 
will have no place to lay their eggs. 5. Put screens on the house 
to keep flies out, and keep the screens closed. 



CHAPTER XIX 

HOW DISEASE GERMS GET INTO WATER 

The water that we drink frequently contains disease 
germs. It is not always the clearest water that is freest 




Fig. 45. An improperly located well; notice lines of seepage. 

from disease germs, for the germs do not make the water 
cloudy. 

Water does not get disease germs from the ground, but 
from man. Almost every town has a sewer system that 
empties into some stream. This practice was started a long 
time ago when men thought that running water would 
purify itself in the course of a few miles. We have learned, 
however, that this is not true. Germs will continue to 
live in running water just as they do in any other water, 
and disease germs will live in a stream from twenty-five 
to thirty-five days. Estimate how far a stream will flow in 
that length of time, and you will know how far disease germs 
will travel in that way. No sewage should ever be allowed 

85 



Why sew- 
age should 
not be 
put into 
streams 



86 



PRINCIPLES OF PUBLIC HEALTH 



Other 
sources of 
germs in 
streams 



to get into a stream until the germs in the sewage have 
been killed. 

Sewage is not the only means by which disease germs are 
carried into streams. Often we find people building barns, 
slaughterhouses, and mills on the banks of a stream. 
The filth from barns and slaughterhouses always con- 




Fig. 46. A properly located well. 



How germs 
get into 
wells 



tains disease germs, and often the filth of mills contains 
poisons that are just as harmful as germs when taken into 
our bodies. None of these things should ever be allowed 
to get into a stream. Water is a very important article of 
food, and we should take every care to keep it pure. 

The water from most wells is clear and cool, but never- 
theless may contain many disease germs. "How does this 
happen ?" you ask. Because the well is too close to an 
out-house or some other source of filth. When a man in 
the country or in a small town builds a house, he imme- 
diately thinks of digging a well just as close to the house 
as he can, so that he need not carry the water far. Next he 



HOW DISEASE GERMS GET INTO WATER 87 

thinks of locating the closet, and this, too, he wants near 
the house. The well and the closet are often near each 
other, and often the closet is on higher ground than the 
well. The vault under the closet is seldom water-tight. 
In fact, the intention of the owner is that a great part of 
the vault contents shall soak away. 

In many localities the ground is an open gravel, and the 
vault contents run through this gravel into the well, carry- 
ing disease germs with them. In one little town, with wells 
as a source of drinking water, the health officers found 
that the closet of every house was draining directly into 
its well. In some countries vaults can be used ; but in any 
region where there is a gravel subsoil, the contents of the 
closet will find their way into the well, unless the closet is 
lower than the bottom of the well. In such places the 
vault must be made water-tight, in order to keep the vault 
contents out of the well. 1 

Springs are usually sources of pure water, but do not Why springs 
think that every particle of water that oozes from the ground 2jwiys pure 
is a spring. Near a certain town is a so-called "very fine 
spring." This "spring" appeared after a man had made 
a cesspool on the hill above, and is simply the drainage 
from the cesspool. Springs that come from deep sources, 
however, nearly always contain pure water. 

1 The cleaning out of these cemented vaults is an exceedingly un- 
pleasant task. Some prefer to have a strong, water-tight box placed under 
the closet seats. When this box is nearly full, it can be removed to some 
place where fertilizer is needed, and there emptied, the contents being 
plowed into the ground. In order to make this task as simple as possi- 
ble, it is a good plan to put the box on skids, and have a heavy strip in 
one end with a bolt and ring through it, so that a horse can be hitched 
to the box to draw it away. If a little dry earth or lime is put into the 
box each day, there will be no unpleasant odor. 



water 



88 PRINCIPLES OF PUBLIC HEALTH 

The safest The safest source of water for domestic use is a stream 

w^r eS that * s known to be free from contamination, or a well so 

deep in the ground that it is hard for any polluting matter 
to reach it. But remember that sewage may follow a well 
pipe along the outside and thus reach even a deep well, if 
the well is not properly protected at the top. 

Keep disease germs out of your drinking water. You 
cannot drown them out and you cannot strain them out, 
so do not let them get in, for you cannot drink water con- 
taining disease germs without running the risk of becoming 
sick. 

Questions, i . Mention more than one way in which germs get 
into streams. 2. How long may disease germs live in running 
water? 3. Mention some instances showing that running 
water does not purify itself. 4. How do disease germs get 
into milk? 5. Describe the proper location of a well in regard 
to refuse. 6. How may springs become polluted? 7. What 
are the best sources of water for domestic use ? 

Remember. 1. Disease germs get into water from dirty 
places along the banks of the streams ; they do not come from 
the ground. 2. Clear water is not always pure; germs do not 
make the water cloudy or muddy. 3. Wells often become in- 
fected by matter from closets seeping into them; make your 
closet water-tight. 4. Spring water is usually pure, but not all 
water that oozes out of the ground is spring water. 




CHAPTER XX 

TRANSMISSION OF DISEASE THROUGH THE AIR 

We take germs into our bodies with the air that we Disease 
breathe. Since we cannot stop breathing and live, we fh™^. m 
must see to it that the air we breathe is kept pure. 

There are always more germs in the air of places in 
which people live closely crowded together than where 
there are only a few people. 
This is proved by Figure 
47, which shows that many 
more germs were found on 
a culture plate exposed in 
the downtown part of New ^ C1 ^ , 

York City than on another FlG 4? . (a) p reva lence of germs 
plate exposed far uptown, in air of thickly populated dis- 

where there are not so many tricts - ( b ) Prevalence of germs in 
. _ . . air of sparsely populated districts, 

people. Remember, how- 
ever, that all germs are not disease germs. 

How do the disease germs get into the air ? When How we 
one sneezes, a spray of droplets is thrown into the ^isease^ 

air. If the person sneezing has the grip, these droplets germs out 
, . . TT7 , of the air: 

contain the germs that cause grip. Whenever a person 

with consumption coughs, he sprays droplets which con- 
tain the germs that cause consumption. 

If a person would hold a handkerchief before his mouth (1) When 
when he coughs or sneezes, these droplets of moisture sneezing ° r 
would not be sprayed into the air, and the disease germs 
in them would not be scattered about. You ask, "Shall 
everyone who is sick hold a handkerchief before the 
mouth when sneezing or coughing?" Everyone, whether 
sick or well, ought to hold a handkerchief before the 

89 



9Q 



PRINCIPLES OF PUBLIC HEALTH 



K2) When 
spitting 



Why well 
people 
should not 
spit on 
floor or 
sidewalk 



mouth when sneezing or coughing. Learn to do this at 
once, and never forget it. 

Another way by which disease germs get into the air is 
from the sputum. People spit on the floor or the side- 
walk, and the sputum becomes dried ; it is then blown about 
as dust. The germs of disease are not killed by drying, and 
when they get into our bodies with the dust which we 
breathe in, they immediately begin to grow. Disease germs 
get into the air chiefly through careless habits of coughing, 
sneezing, and spitting, and these careless habits can easily 
be prevented. 

A boy once said that if he saw a consumptive spit on the 
sidewalk, he would want to hit him, and to emphasize his 
remarks he spat on the floor of the room, just as you have 
seen boys spit on the ground when they were thinking of 
fighting. There might have been some germs of consump- 
tion in the sputum this boy left on the floor. Of course 
he was very positive that he did not have consumption, but 
this was no proof that his sputum was free from the germs 
of this disease. 

Remember that it is not only the sick who should never 
spit on the floor or sidewalk, but that no person should 
ever spit on any floor or sidewalk, or into any place 
except into a cuspidor, handkerchief, or spit-cup of some 
kind. If you spit into a handkerchief, a paper napkin, or 
a bit of cloth, be sure to burn it as soon as you can, 
before it becomes dry. 

Questions, i. In what places do we find germs most abun- 
dant in the air? 2. How do well-bred people avoid putting 
disease germs into the air? 3. Why is it important for well 
people to take the same precautions as sick people? 



DISEASE THROUGH THE AIR 91 

Remember. 1. Every person should hold a handkerchief be- 
fore the face when coughing or sneezing. 2. Never spit ex- 
cept into a cuspidor, handkerchief, spit-cup, or other special 
receptacle. 3. If well people will practice clean habits, the 
sick will be helped and encouraged to follow their example. 
4. Remember: No spit, no consumption. 



CHAPTER XXI 



INSECTS AS CARRIERS OF DISEASE 



Some in- 
sects that 
carry disease 



How yellow 
fever is 
transmitted 



How malaria 
is trans- 
mitted 




Certain diseases are given to human beings by the bites 
of insects. We know that certain ticks and mosquitoes 
carry certain germs. It is also probable that disease germs 

are transferred from diseased 
to well persons by bedbugs and 
other insects that bite. 

For a long time it w r as 
thought that yellow fever was 
carried through the air, but 
now it has been proved that 
yellow fever is not carried in 
this way. A well person can 
sleep with one who has yellow 
Fig. 48. The mosquito that fever and not catch the disease, 
carries yellow fever. Yellow fever infection is carried 

from a yellow fever patient to 
a healthy person only by a certain mosquito. Keep this 
mosquito away from the yellow fever patients and there 
can be no spread of the disease. 

It is not many years since yellow fever was one of the 
most dreaded diseases in warm countries. To-day there 
is not the same fear of it, for the source of the disease has 
been discovered and practical methods have been devised 
to get rid of the mosquito which carries it. 

Malarial fever is another disease transmitted by the 
bite of a mosquito, but the mosquito that carries malarial 
fever is not the same as the one that carries yellow fever. 
For a long time it was supposed that malaria, came from 
the gases which rise from marshes. To-day it is known 

92 



INSECTS AS CARRIERS OE DISEASE 



93 




Fig. 49. One of the 
places where mosquitoes 
hatch. 



that it is not the gases that cause 
the sickness, but a mosquito 
which lives and grows in the 
marshes. Many countries that 
have heretofore been practically 
worthless on account of malarial 
fever, are being made valuable 
by draining the marshes and do- 
ing aw 7 ay with places where mos- 
quitoes can hatch. 

It might seem a very hard task How to get 
to get rid of mosquitoes in coun- moS q U i t o 
tries where there are so many of 
them; but it can be done. The 
mosquito must have still water in 
which to lay her eggs. In coun- 
tries w r here there is danger of 
yellow fever or malaria, the rain 
barrel and the cistern should be 
screened, and the swamps and 
water holes filled up. Puddles of 
water should not be allowed to 
form anywhere, and 1ow t places 
where water might stand should be 
drained. By giving her no place 
in which to lay her eggs, we can 
get rid of the mosquito ; and when 
the mosquito disappears, yellow 
fever and malaria disappear also. 

In certain portions of Mon- How wood- 
tana, Washington, Idaho, Utah, mit disease 



94 PRINCIPLES OF PUBLIC HEALTH 

and Wyoming, there is a peculiar disease known as 
Rocky Mountain spotted (tick) fever. It is now known 
that this disease is transmitted to people by the bite of a 
wood-tick. Not all wood-ticks carry this fever, and for 
people living in districts where this disease does not exist 
there is no danger in the bite of a wood-tick; but in a 
part of the country where the disease prevails, the wood- 
tick should be avoided. 

How disease- All insects that are knowm to transmit diseases can be 
bearing in- , . TJ . . n . . 

sects can destroyed. It we will do away with stagnant water, the 

be destroyed mosquito cannot hatch; if we will cut out underbrush and 

oil the domestic animals, the wood-tick will not find a 

place to grow. If we wish to get rid of disease, we must 

spend money and labor; but it is worth while, for human 

life is at stake. 

Questions, i. What insects are known to transmit diseases 
to man? 2. How is yellow fever transmitted? 3. Malarial 
fever? 4. What disease is transmitted by the wood-tick? 
5. How can we get rid of the mosquito? 6. How can we get 
rid of ticks? 

Remember. 1 . It is a proved fact that diseases are transmitted 
to man by the bites of mosquitoes and wood-ticks. 2. It is 
possible to do away with both the mosquito and the wood-tick 
almost completely, although it requires a great deal of work and 
the expenditure of a large amount of money. 3. Health is the 
most valuable thing we have, and it is foolish to hesitate in 
giving the work and money necessary to exterminate disease- 
bearing insects, as well as the many other causes of sickness. 



CHAPTER XXII 



HOW TO KEEP GERMS OUT OF WOUNDS 



Germs get into our bodies through breaks in the skin. How germs 
These breaks may be made by a cut or a scratch, by the f^ skin Ugh 

bite of an insect, or even by the 
pulling out of a hair. There 
are some special germs, such as 
those which cause yellow fever, 
which are introduced by the 
bite of an insect ; but at present 
we will consider only those 
germs that would naturally 
enter through any break in 
the skin. 

The skin of the human body Effect of 
acts as an armor against certain ^^™ 
germs that are constantly try- 
ing to get through it. There 
are several germs of this class. 
Some of them cause white pus, 
or matter, but this is the least 
dangerous kind of all. Another 
kind causes boils or even blood 
poisoning, and another kind 
causes erysipelas. 

We cannot get rid of these 

germs, for they are everywhere, 

to a greater or less degree ; but 

they are more abundant in dirty than in clean places. 

They cause every degree of inflammation, from a slight 

redness of the skin to the blood poisoning that brings death. 

95 




Fig. 50. Small, deep wounds 
are very liable to become 
infected. 



9 6 



PRINCIPLES OF PUBLIC HEALTH 



Real cause 
of suppura- 
tion 



How the 
surgeon 
prevents 
suppuration 



Sometimes you will hear people say that a wound sup- 
purated (that is, became inflamed and full of matter) be- 
cause the blood was in bad condition. As a matter of 
fact, there would have been no suppuration if germs had not 
got into the wound. It was not the condition of the blood 
that caused the suppuration, but the germs. 

Sometimes, when only a few germs get into a wound, and 
w r hen the cells of the body are all in good condition and 
doing their work properly, the suppuration will be very 
slight, because the healthy cells of the body will kill the 
germs. But if very many germs get in, even healthy body 
cells cannot kill them all. 

We have said that the germs which cause suppuration are 
everywhere, so it would seem almost impossible to keep 
them out of a wound. This is true in a sense; but even 
after they have got into a wound, you can wash them out if 
you use plenty of soap and water to cleanse the wound 
thoroughly. When I said that it is impossible to keep them 
out of a wound, I meant an accidental wound, for it is 
quite possible to keep them out of a wound that is made 
intentionally, as is done by the surgeon. 

Do you know how a surgeon gets ready to do an opera- 
tion? The first thing he does is to see that the room is 
perfectly clean. He has the carpet taken up, the cur- 
tains taken dow r n, and the floor and walls washed. This 
is to get rid of all the dirt and germs in the room. If you 
should look at the surgeon's instruments, so clean and 
bright, you would think it impossible for a germ to find a 
place to live on; but the surgeon knows how closely the 
germs cling, and therefore he boils all the instruments he is 
going to use. Then he puts the towels into a place where 



HOW TO KEEP GERMS OUT OF WOUNDS 07 

they arc made so hot by steam that all the germs on them 
are killed. After everything in the room is perfectly clean, 
the surgeon cleans his patient with a very stiff brush, 
using plenty of soap and water which has been boiled to 
kill all the germs in it. He scrubs the part where the 
wound is to be made and the skin around it until it is 




Figs. 51 and 52. Always wash the simplest cut with soap and 
water; failure to do this may result in infection and much suffering. 



red. Even then he is not satisfied, for he washes it off with 
alcohol and ether, to be sure that any germs that might be 
sticking in the fat are removed. He scrubs his hands in 
the same way. After all this is done, he can perform the 
operation without fear that any of the germs which cause 
suppuration will get in, for he knows that he has killed all 
of them that would touch the wound. 

Boys and girls cannot do all this before they cut their How to 
hands or skin their shins, but they can do the next best suppuration 



9 8 



PRINCIPLES OF PUBLIC HEALTH 



Where 
germs of 
lockjaw 
grow 



thing — they can keep their hands and the rest of their 
bodies clean at all times, and thus have as few germs on 
them as possible. Then, when they have cut themselves, 
they can go straight to some place where there is soap and 
water, and can wash the wound thoroughly. After this is 
done, a clean bandage should be placed on the cut part to 
prevent any other germs from getting in. If this is done 
every time you cut yourself, you will probably never have 
an infection — that is, a wound that suppurates. 

Two boys were playing together one day. They ran into 
each other and each got a little cut on his hand. One boy 
went home at once, washed the wound, and put on a clean 
bandage. He lost a little time from his play, but was soon 
back and never had any trouble on account of the cut. 
The other boy thought it was foolish to quit his play to take 
care of such a little thing, so he tied his hand up in a dirty 
handkerchief. Two weeks later he was very ill. His arm 
was badly swollen and had to be cut open in several places ; 
indeed, he came near losing his arm. It always pays to 
take care of a wound, be it never so slight. 

Deep wounds made with small instruments, such as 
small knives, nails or toy pistols, are especially dangerous, 
because they are hard to clean and because they quickly 
heal up on the surface and leave the germs to grow at the 
bottom of the wound. Such wounds as these are danger- 
ous for another reason. 

There is a germ that gets into wounds but does not cause 
suppuration. It is the germ of tetanus, or lockjaw. It 
lives in the ground, especially in the ground about barns, 
and its peculiar feature is that it will not grow in the air. 
If it gets into a large, open wound, it is easily killed, because 



HOW TO KEEP GERMS OUT OF WOUNDS 99 

it cannot grow where there is air. But when it gets into a 
small, deep wound where it cannot be reached, it stays 
there until the wound heals over on the surface, and then it 
begins to grow. It does not make the parts swell, as the 
germs of suppuration do, but quietly continues to grow, 
without the wound showing any sign of infection. Fi- 
nally it develops a very severe poison that is taken up by the 
blood; then the victim suddenly begins to have spasms 
about the face, and finally these spasms extend to the entire 
body and kill him. Whenever you get a wound so deep 
that you cannot wash it thoroughly, go to a doctor and let 
him clean it out with some medicine that will kill the germs 
that cannot be reached by washing. 

Sometimes the germs that cause suppuration get under How boils 
the skin at a point where a hair has been pulled out, or 
even work down beside the hair itself. When this hap- 
pens, they cause suppuration under the skin, and the result 
is a boil. A boil is merely an infection with the germs that 
cause suppuration. 

Questions, i. How do germs get through the skin ? 2. Can 
we get rid of all the germs that cause suppuration ? 3. Why is 
'it impossible for "bad blood" alone to' cause suppuration? 
4. How does the surgeon prevent suppuration? 5. How may 
you prevent suppuration? 6. What is the danger of cutting 
corns with an ordinary knife or razor? 7. Where do germs of 
lockjaw grow? 8. What causes boils? 

Remember. 1. Germs and not "bad blood" are the cause of 
suppuration. 2. Always keep as clean as possible, and imme- 
diately wash any cut, no matter how small. 3. If you have 
a deep wound, go at once to a doctor, and let him clean it out 
and kill the germs that may be at the bottom of the wound. 



are caused 



CHAPTER XXIII 



TRANSMISSION OF DIPHTHERIA 



How germs 
may cause 
sickness 
without 
entering the 
body 



Prevalence 
of diphtheria 



Where the 
diphtheria 
germ comes 
from 



Some germs that cause disease do not get into the body, 
but grow upon its surface, that is, they grow on the mucous 
membranes — the skin of the mouth, the throat, and the 
nose. As they grow, they develop poisons that are ab- 
sorbed by the body, and that make us very sick. The 
germs that cause diphtheria belong to this class. 

Diphtheria is one of the most common of all the pre- 
ventable diseases. It causes more deaths than any of the 
other diseases that can be prevented, except tuberculosis. 
The great prevalence of diphtheria is due to lack of care 
on the part of those who have this disease and of those 
who come in contact with them. 

The germ that causes diphtheria always comes from 
some person or animal that has diphtheria. It never 
" just happens." If you went into your yard in the morn- 
ing and found some beets growing in your flower bed, you 
would know positively that beet seeds had got into your 
flower bed in some way. You would not say that the beets 
just happened to grow there. So diphtheria will not " just 
happen." Diphtheria is always caused by germs that come 
from some one who has diphtheria. They may have come 
in a letter that was written in the room with the sick per- 
son. They may have come from the library in a book that 
had been used by some one ill with diphtheria. They may 
have come on some toy that had been played with by a 
child that had the disease. There are a thousand ways by 
which the germs may be brought to you without your 
knowing where they come from. 

The public health officers try hard to keep these germs 



TRANSMISSION OF DIPHTHERIA 



IOI 



from being brought to you. In order to do this, they have How to 
to shut away from other people those who have diphtheria diphtheria 
germs; that is, they make the sick ones stay at home until g erms 
they are free from the germs of the disease. We call this 
quarantine. Quarantine means that you must stay away 
from other people when you are sick with a communicable 




Fig. 53. Disease germs are as deadly as guns. 



disease, and that other people must stay away from you. 
People are not put in quarantine because they are sick, but 
because they are dangerous, and because we are trying to 
prevent other people from getting the same disease. Do 
not think the health officers unreasonable when they 
tell you that you must stay at home and that no one 
can come in to see you. This is done to protect other 
people and to keep them from getting the same disease 
that you have. If you ever have diphtheria, or any other 
communicable disease, you must remember that if any 
of your playmates come in to see you, they may get the 
same disease. 

Diphtheria kills a great many children, and to play with Seriousness 
your friends after you have had diphtheria, and before the q ua rantine S 
health officer tells you that you may, is almost like trying 



102 



PRINCIPLES OF PUBLIC HEALTH 



Why 

quarantine 
is not raised 
sooner 



Why some 
cases of 
diphtheria 
escape 
quarantine: 



to kill them. They might be very sick and die, or they 
might be very sick and get well, or they might not be sick 
at all ; but you never can tell what will happen if they are 
exposed to the disease. If you were to take a gun and 
shoot at a friend, you might kill him, or you might shoot 
his leg off, or you might not hit him at all ; but you would 
be trying to hit him, and it would not be your fault if you 
did not. It is just the same if you play with a friend when 
you have a communicable disease; you shoot the disease 
germ at him, and if you do not hit him, it is not your fault. 

Sometimes people who have been sick with a communica- 
ble disease feel perfectly well, but the health officer tells 
them he cannot let them out of quarantine. This is be- 
cause he knows that such people still have in their bodies 
the germs that cause the disease, and that as long as these 
germs are there they can give the disease to other people. 
It is not pleasant to have to stay in quarantine when you 
feel that you are well, and children, as w^ell as older people, 
are very likely to become restless under the circumstances. 
You see an illustration of such a patient in Figure 60, where 
the little girl, who is under quarantine for scarlet fever, but 
who is feeling quite well, is giving a book to two of her 
friends. The book contains the germs that cause scarlet 
fever, and the boys are very likely to contract the disease 
by handling the book. 

If every case of diphtheria were quarantined, and the 
people obeyed the health officer, there would soon be 
no more diphtheria. But how does it happen that every 
case of diphtheria is not quarantined? Diphtheria is a 
very peculiar disease. Sometimes it makes people so sick 
that they die in spite of everything that can be done for 



TRANSMISSION of diphtheria 



103 



them; sometimes it makes the throat only a little sore, 

and the child seems so slightly ill that his mother says to 

herself, "He is fretful," and does not call the doctor. In 

the latter case the child often keeps on going to school, and 

exposes other children to the disease; some of them catch 

it, and become very sick or 

even die. In still other cases, 

the mother thinks that a child 

has only a case of tonsillitis 

and does not call a doctor; 

the child's brothers and sisters 

go to school and may carry 

the germs to other children. 

I have known a great many 

cases of diphtheria to be spread 

in this way. 

Sometimes a dairyman 
thinks that his child has noth- 
ing more serious than tonsil- 
litis, and goes on selling milk. 
A great many epidemics have 
resulted from such cases. Sore 

throats should not be treated lightly, for the most severe 
forms of diphtheria may develop from germs that come 
from a throat that is only slightly sore. If there is a 
case of diphtheria in the town where you live, and if your 
throat feels the least bit sore, have your doctor examine 
it at once. If you do not wish to have your family doctoi 
look at your throat, go to the health officer. Had you not 
rather stay at home for a week or two than see your best 
friends ill or dead because of your carelessness ? 



(/) From 
failure to 
detect mild 
cases 




Fig. 54. The old, insanitary 
slates and sponges have gone 
out of use, but many people 
of to-day still follow the dan- 
gerous habit of putting pencils 
into their mouths. 



io4 



PRINCIPLES OF PUBLIC HEALTH 



[2) From 
diphtheria 
germs in 
throats that 
are not sore 



How mild 
cases may 
be detected 



There is another peculiar thing about the germ of diph- 
theria. It will often get into a throat and grow a little, 
just enough to keep alive, but without making the throat 
sore at all. The person in whose throat the germs are will 
have no idea that they are there, but when he comes in con- 
tact with some one who has a delicate throat, he may give 
diphtheria to that person. The disease does not develop 
in some throats because the body cells are all healthy and 
doing their w r ork so well that, when the diphtheria germs 
try to take hold, they are driven off and not allowed to 
grow. This is the reason that, before he raises the quar- 
antine, the careful health officer takes a "culture" from 
the throat of everyone in a house where there has been 
diphtheria. 

The health officer takes a culture by wiping the throat 
with a little cotton on a long stick, which he then puts down 
into a long glass tube containing some substance that diph- 
theria germs like to grow on. If there are any diphtheria 
germs in the throat, they will soon show on this culture 
material. Then the health officer wall say, "No, we cannot 
let you out yet, for the germs are still in your throat." No 
person who has been staying in a house where there is 
diphtheria should be allowed to go out until a culture proves 
that his throat is free from the germs of diphtheria. 

You see how hard it is to quarantine all cases of diph- 
theria, when children are sometimes allowed even to go to 
school with sore throats that are really diphtheritic. Only 
two things are necessary for getting rid of diphtheria: one 
is to quarantine every case, and the other, to have the 
people do just what they are told when under quarantine. 
This latter is just as important as the quarantine itself, 



TRANSMISSION OF DIPHTHERIA 



IOq 



for people often do not obey the health officer's directions. 
Now let us see what are some of these directions. 

If you are the patient, the health officer will say that you Rules of 
must be put in a room where there is just enough furniture <l uarantme 
to make you comfortable, and that 
no one except the nurse and the 
doctor is to go into that room. He 
will say that the nurse must stay in 
your room all the time, or that she 
must at least not go into any other 
room in the house ; that your meals 
must be left outside your door, and 
that the person who brings them 
must go away before the door is 
opened by the nurse. Furthermore, 
as everything in the room that can- 
not be boiled, or otherwise disin- 
fected, will have to be burned when 
you are well, your pet books and 
toys had better not be taken in. 

Finally, nothing is to be carried 
from the room until it has been put 
into a solution that will kill the 
germs, and this means not only 
dishes, bedding, and clothing, but 
even books and letters. The nurse 
must see that all discharges from 
the throat and nose are received on 
little cloths, which are to be burned immediately. 

These are the things that the health officer will tell your How quar- 
parents must be done. Now let us see what sometimes are^roken 8 




Fig. 55. How pets may 
become carriers of dis- 
ease. 



106 PRINCIPLES OF PUBLIC HEALTH 

happens. Your mother will want to see her little child so 
much that she cannot wait until you are well, so she will 
slip into your room, kiss your forehead, and hold you tight 
against her. When a little later she kisses your baby 
brother, and is so thankful that he is not sick too, she does 
not realize that she is kissing the very same disease into his 
little throat. Or, perhaps your mother is the nurse, and in 
the night she hears your little brother crying; she thinks, 
" Surely I can slip out and just cover him up; it will not 
hurt him just for once," and she does so. What happens? 
In a few days your doctor tells you that your little brother 
will have to come in and stay with you, 

Perhaps your father grows anxious to see you, and one 
morning he says he cannot stand it another minute, 
so he slips in for a few moments before going to business. 
In a few days one of his clerks fails to come to work. Your 
father sends a messenger to see what the trouble is, and 
the word comes back, "He has diphtheria." Then your 
father says, "What are these health officers doing that they 
do not stop this thing ? " He is very indignant, but it never 
occurs to him that he himself has spread the disease by do- 
ing just what he promised the health officer he would not do. 
How dogs The doctor told your mother not to take anything from 

3.11(1 C3.t^5 

carry dis- the room until it had been disinfected. But you do not con- 
ease germs siderTowser, your dog, and Tabby, your cat, "anything," 
so you persuade your mother to let them come in, and you 
have a good play with them. You let them rub against 
your face and romp on your bed, and do everything that 
pet dogs and cats like to do, and in the meantime their fur 
is getting full of diphtheria germs. Then Towser and 
Tabby run out-of-doors and play with the boys and girls 



TRANSMISSION OF DIPHTHERIA 107 

of the neighborhood. Socn the parents are wondering why 
the health officers do not stop the spread of the disease. 
No dog or cat should ever be permitted to come into a 
house where there is a contagious disease. 

These are not all the ways in which people disobey the 
orders of the health officer and of the doctor, but these are 
enough to' show you that it is a very important thing to do 
just what they tell you. It is not always easy to follow all 
these rules, but it is far better to follow these, and many 
more, than to have to think that you have caused the death 
of either a friend or a stranger. 

Questions. 1. How does the poison of diphtheria get into 
the system? 2. Where does the diphtheria germ come from? 
3. What is quarantine? 4. What is the danger in breaking 
quarantine? 5. Why is quarantine continued after you feel 
well? 6. How does it happen that some cases of diphtheria 
are not quarantined? 7. What is a diphtheria culture? 
8. W 7 hat rules should you observe while in quarantine? 9. 
Tell some of the ways by which quarantine is broken. 10. 
How do pet dogs and cats sometimes get disease germs ? 

Remember. 1. The germs that cause diphtheria always come 
from some person or animal that carries diphtheria germs. 
2. Diphtheria is always caused by the diphtheria germ, and 
the diphtheria germ cannot cause any other disease. 3. People 
are quarantined to prevent other people from getting the dis- 
ease. 4. If there is diphtheria in your neighborhood, and 
your throat becomes sore, have the doctor examine it. 5. Every 
person who has been staying in a house where there is a case of 
diphtheria should have his throat examined to make sure he is 
not carrying germs. 6. Never play with dogs or cats when you 
have a contagious disease. 7. People who do not obey quar- 
antine regulations cause a great deal of suffering and many 
deaths. 



CHAPTER XXIV 



THE CURE OF DIPHTHERIA 



Nature of 
diphtheria 
poison 



How diph- 
theria toxin 
is fought 



The germs of diphtheria do not get into the blood through 
the skin, but grow on the surface of the mucous membrane 
(skin of the throat) , and there produce a poison that gets 
into the blood through this membrane. It is this poison 
that makes you sick, and it is called a toxin. You already 
know that when people have diphtheria, they are some- 
times very sick and sometimes only slightly sick, and that 
the germ can live in some throats without causing any ill 
effects whatever. 

As soon as the diphtheria germ begins to grow in a 
throat, the little cells of the body begin to make a certain 
substance and to pour it into the blood. This substance 
we call antitoxin, which means opposed to the toxin in the 
blood. If the little cells make the substance fast enough, 
the germs will stop growing, or in some cases they never 
really get started growing, because they cannot exist where 
there is much antitoxin. Antitoxin looks like clear water. 
The following experiment will show you something that 
acts in very much the same way that antitoxin does. 

If you take a solution of litmus that is. made alkaline, 
it will be very blue, like indigo ; but if you drop a few drops 
of lemon juice into this solution it will turn red. 1 Lemon 
juice is acid, and is just the opposite of alkali. Now, if 
you put a few drops of ammonia, which is alkali, into the 
red solution, it will turn blue again. If you put a little 
more lemon juice, very carefully, drop by drop, into the 
blue solution, it will gradually turn lighter, until it is 
entirely clear. 

1 The teacher should demonstrate the action of acids and alkalies on 
a solution of litmus. 

108 



THE CURE OE DIPHTHERIA IOQ 

We will suppose that the blue is due to the toxin pro- How anti- 
duced by the diphtheria germ, and that the lemon juice oxin acts 
is the antitoxin produced by the cells in the body. If the 
antitoxin is made fast enough, the blue disappears; but 
if the toxin is made faster than the antitoxin, the blue 
remains. It is the same way in the body, only it is not 
litmus and acids and alkalies that we have to deal with. 
If the toxin is made faster than the antitoxin, the germs 
grow, and we get sicker and sicker; but if the antitoxin is 
made faster than the toxin, then the germs cannot grow, 
and we soon get well, or perhaps do not get sick at all. 

Doctors knew that this was what happened, but for a How anti- 
great many years they could not discover the composition of |jj™* *"*. 
the antitoxin that is made in the body. One day a doctor 
suggested, "If we cannot find out the chemical nature of 
this thing that is made in ther body, why can we not make 
it in the body of some animal and then use the blood of the 
animal?" And that is just what they did. They put 
diphtheria germs into beef tea, and let them grow very 
fast and make all the toxin they could. Then the doctors 
strained the germs out by passing the beef tea through a 
fine filter, in this way getting the poison, and not the germs. 
Then they gave a strong, healthy horse a small quantity of 
this poison ; they did not feed it to him, but injected it into 
his blood. Of course the horse was sick for a while, but 
soon he began to get well again, for the cells in his body 
immediately went to work making antitoxin. 

When the horse was well, the doctors gave him more of 
the poison ; this time he was not so sick and got well even 
more quickly. This treatment with toxin was repeated in 
gradually increasing doses until the poison did not affect 



no 



PRINCIPLES OF PUBLIC HEALTH 



Evidences 
that anti- 
toxin saves 
lives 



How anti- 
toxin saves 
lives 



the horse at all. Then the doctors said, "His blood is full 
of antitoxin, and we will see what it will do when injected 
into some other animal." So they drew off some of the 
horse's blood and took out all the little red cells, leaving 
nothing but the clear fluid of the blood. They planted diph- 
theria germs in a rabbit's throat, and when the rabbit 
became very sick, they gave him 
some of the antitoxin from the horse. 
The rabbit immediately got well. 
Afterward they gave some of this 
antitoxin to a little boy who was 
very sick with diphtheria, and he, 
too, got well. Ever since then the 
doctors have been saving many lives 
by the use of antitoxin. 

Someone may ask, "How do we 
know that it is the antitoxin that 
saves lives?" In just this way: be- 
fore we knew anything about anti- 
toxin, about half of all the people 
with diphtheria died; but since we 
have had antitoxin, only about 
twelve die out of every hundred 
who have this disease. More than this, we know that 
when the antitoxin is given within the first twenty- four 
hours after the patient is taken sick, there is only about 
one death for every one thousand cases of diphtheria. 
Do you not think that this is strong proof that antitoxin 
saves lives? 

Antitoxin saves lives not only by curing those who have 
diphtheria, but by preventing others from having it. If 



1st 

day 

2nd 
day 

3rd 
day 

4th 
day 

5 th 
day 



no deaths 



5 deaths 



11 deaths 



ig deaths 



20 deaths 



Fig. 56. Showing the 
number of deaths in 
100 cases of diphtheria 
when antitoxin is used 
on the first, second, 
third, fourth, and fifth 
da vs. 



poison 



THE CURE OF DIPHTHERIA III 

a person who has been where there is a case of diphtheria 
is given a dose of antitoxin, he will not have the disease, 
because his blood will contain enough antitoxin to destroy 
the diphtheria toxin present. If you will watch a careful 
doctor when he makes his first visit to a case of diphtheria, 
you will notice that, as soon as he gets through treating the 
patient, he gives all members of the family who have been 
near the patient a dose of antitoxin to keep them from 
getting sick. 

Some people may tell you that antitoxin is a poison and Antitoxin 
should not be used. The statement that it is in itself a 
poison is true. But it is also true that in your body there 
are many things that would poison you if you got too much 
of them. For instance, there is a gland in your throat 
(the thyroid) which secretes a substance that is necessary 
for your health, but if you were to take the secretion of 
ten such glands it would kill you at once. Now, if the cells 
in your body make antitoxin when you have diphtheria, it 
is probable that antitoxin is the very thing needed. And 
if you can help these cells by giving them antitoxin, ready- 
made, does it not seem a reasonable thing to do ? People 
who give the name of poison to a substance which is known 
to have saved many lives are not worthy of attention. 
Anything may prove a poison if taken in excess ; too much 
play will prove a poison, and too much work also. 

Questions, i. What is the poison of diphtheria called? 
2. What is antitoxin? 3. Compare the action of antitoxin 
on the blood with the action of an acid on the litmus solution. 
4. Tell about the discovery of antitoxin. 5. How do we know 
that antitoxin saves lives? 6. How does antitoxin prevent 
diphtheria? 7. Why should antitoxin not be regarded as a 
poison ? 



112 PRINCIPLES OF PUBLIC HEALTH 

Remember, i. Antitoxin is what the cells in your body make 
when you have diphtheria. 2. By using the antitoxin taken 
from a horse, you save your own cells the struggle necessary to 
make it fast enough to kill the diphtheria germs. 3. If you 
have diphtheria, and antitoxin is given promptly, you will get 
well. 4. If you have been exposed to diphtheria, antitoxin will 
prevent your having the disease. 5. Antitoxin is no more a 
poison than are many other medicines. 



CHAPTER XXV 

HOW TYPHOID FEVER GERMS ARE CARRIED 

There arc certain diseases, the germs of which get into How ty- 
our bodies through our mouths. That is, we eat or drink gems^et* 
them. Some of these diseases are typhoid fever, cholera, into the 
the summer complaints of children, tuberculosis, and 
diphtheria. At present w r e shall learn about the germ 
that causes typhoid fever, how it gets into our food and 
drink, and how we may prevent the disease by getting 
rid of this germ. 

Typhoid fever, like all other diseases caused by germs, 
is caused by one kind of germ, and one kind only. You 
cannot get typhoid fever by eating cholera germs any more 
than you can get diphtheria from typhoid germs. 

So far as we know, there is no animal except man that Animals 
has typhoid fever. Since the germs of any disease must x re ^ f ^? m 
come from an animal suffering from that disease, and as 
man is the only animal that has typhoid fever, it naturally 
follows that the only way to get typhoid fever is from 
some person who has the fever or has had it. 

We know that typhoid fever germs get into the body with How ty- 
food, but how do they get out ? Once in a great while germs f ea ^ e f^™* 
are found in the matter that the patient vomits, or spits up, bod y 
but this is a rare occurrence, so rare that we need hardly 
consider it. The germs are present in the blood of the 
sufferer, but other people do not get his blood on their 
hands or in their food. There are two things that come from 
the patient that are loaded with these germs, and these are 
the urine and bowel discharges. In these two excretions 
of the body are found practically all the typhoid germs that 
come from the patient, and these are the causes of other 

113 



114 



PRINCIPLES OF PUBLIC HEALTH 



How ty- 
phoid germs 
get into 
water 



The wide- 
spread evil 
due to the 
sickness of 
one person 



infections. In other words, it is from these two excretions 
that the germs get into food and drink. 

How do the typhoid germs 
get into our food? What is 
done with the excretions after 
they come from the body? 
You will probably say that the 
nurse throws them into the 
sewer. Very true ; but where do 
they go when they are thrown 
into the sewer? The sewer 
must empty somewhere, and in 
most instances it empties into 
a stream, the water of which 
is used for drinking purposes. 

You may think that the 
germs from one person would 
not make much difference, but 
that is where you are mistaken. 
There is a town in Pennsyl- 
vania of about eight thousand FlG 5? Pollution of a stream 
inhabitants, which gets its w ith sewage, 

water from a stream that flows 

down from the mountains. One cold winter, while the 
stream was frozen, a man living on the bank of the stream 
was taken sick with typhoid fever. His nurse threw the 
urine and the discharges from his bowels on the ice on the 
bank of the creek. When the ice melted, the typhoid 
germs in the discharges found their way to the stream 
that furnished drinking water to people farther down, and 
in a very short time there were over one thousand cases of 




HOW TYPHOID FEVER GERMS ARE CARRIED I 15 

typhoid fever in that town. Before the ice melted there 
had not been a single case of typhoid, and every one of the 
thousand cases came from the water into which had been 
allowed to flow the discharges from one man with typhoid 
fever. You see what germs from one person may do. 

Sometimes people say that a stream purifies itself every How long 
few miles. It does purify itself of some things, but disease ^^e^g 
germs live from twenty-five to thirty-five days in water, and live in a 
a stream flows a long way in thirty days. 

Sometimes we hear people say that it is safe to put sewage The pollution 

into a certain stream, because no town uses that stream for of streams 

with sewage 

drinking water. But of this they can never be sure. Not 
long ago certain people said that the water from the river 
which flowed through their town was used only by two 
dairymen and a vegetable gardener, and therefore there was 
no danger in running sewage into the stream. Yet the 
dairymen and the gardener sold all their produce in that 
very town. The townspeople never considered that the 
water into which they ran their sewage was used by the 
dairymen for washing their milk vessels (and perhaps for 
diluting the milk), and by the gardener for washing his 
lettuce and other vegetables. Thus the germs of disease 
were brought directly back to the town. 

Do not think that you are safe in polluting a stream 
with sewage because no town uses the water from that 
stream. The individual on the farm is entitled to pro- 
tection just as much as the individual in the town. Al- 
ways remember that when you pollute with disease the 
water used by the farmer, he may bring that disease back 
into the town with the produce of his farm. 

No sewage, no matter how small the amount, should ever 






Il6 PRINCIPLES OF PUBLIC HEALTH 

be permitted to go into a stream until all the disease germs 
it contains have been killed. This can be done, though 
it will cost something; but we cannot get rid of disease 
germs without work, and work cannot be done without 
being paid for. 

There are other ways of scattering typhoid germs 
besides running sewage into streams. Sometimes the 
nurse does not throw the discharges from a typhoid 
fever patient into a sewer at all, but into a closet vault. 
Remember how the material from a closet vault goes 
through open ground into a well, and you will understand 
what happens. The germs get into the well, and the 
whole family may then have typhoid fever. 

Let us suppose that the nurse did not throw the dis- 
charges either into the closet or into the sewer, but carelessly 
threw them out on the ground behind the house, where, as 
it was winter time, they froze as hard as rocks. It does not 
seem to hurt typhoid germs in the least to be frozen ; when 
they get warm again they are as lively as ever. Let us 
suppose these particular germs lay there all winter, but in 
the spring when everything melted the germs were still 
alive and ready to spread disease. It happened that they 
did not get into the well or into the milk, but they did get 
on your food, and made you ill with typhoid fever. 
How flies How did the germs get to your food ? About the time that 

phoid germs t ^ ie g erms were thawed out, and were beginning to double 
in number every hour or two, along came a fly and thought 
that spot an attractive one for a lunch. Accordingly he 
walked over this mass of filth, collecting a supply of germs 
on his feet, and then* came in and tracked them over your 
bread and butter or other food. 



HOW TYPHOID FEVER GERMS ARE CARRIED I 17 




That is how you got the fever; but the trouble did not 
stop with you. When you fell sick, your father thought it 
was time to clean the yard, but he was not very careful 
what he did with the dirt, including the typhoid fever 
discharges which the nurse threw out on the snow during 
the winter. There was a low place 
in the barnyard and there he dumped 
the dirt. One of the cows thought 
this fresh pile of dirt would make 
a comfortable place to lie dow r n 
in. The next morning the milk- 
man milked her without first wash- 
ing her sides and udder, and hun- 
dreds of little particles of dirt, each 
one loaded with germs, fell into the 
milk. The milk from all the cows 
was mixed together, and by the time 
it got to town these germs had 
grown into many thousands. Some 
of the people w T ho drank the milk became ill with 
typhoid fever and w r ondered afterward where they had 
taken this disease. 

The discharges from a typhoid fever patient contain 
typhoid germs not only while the disease lasts, but for 
many months after the patient is well. In some cases 
they are present for years after the illness is over. 

Here is a story about typhoid fever that illustrates the 
importance of washing and boiling everything that comes 
from a sickroom. A few years ago there was an epidemic 
of typhoid fever in a certain town. One of the hospitals 
w r as very much crowded, and it became necessary to employ 



How ty- 
phoid germs 
get into 
milk 



Fig. 58. Flies crawl- 
ing on the edge of the 
glass or falling into the 
milk leave germs that 
cause disease. 



Why the 
recovered 
patient is 
dangerous 



The story 
of the care- 
less nurses 



Il8 PRINCIPLES OF PUBLIC HEALTH 

several extra nurses. All the nurses knew the importance 
of washing their hands after handling the patients, and the 
old nurses had seen so many bad results from failure to 
observe this rule that they were very careful. Three of the 
new nurses, however, thought it a great deal of trouble to be 
washing their hands all the time, so more and more they 
neglected this important duty. The result was that all 
three of these girls got typhoid fever and died. They paid 
the penalty for neglecting the duty that they well knew 
they should have performed. 

Typhoid fever can be wiped out by attention to neg- 
lected details — that is, by disinfecting discharges before 
throwing them away; by disposing of excretions only in 
places that are made for them; by adding lime to the 
closet vault every day to kill any germs present; by mak- 
ing the closet in such a way that flies cannot get into it; 
and by not permitting sewage to enter any stream until all 
the disease germs have been killed. All these things can be 
done. It will require a little work; but had you not rather 
take a little extra care than run the risk of catching or 
spreading typhoid fever? 

Questions, i . How do typhoid fever germs get into the body ? 
2. What is one source of these germs ? 3. How do these germs 
leave the body? 4. Name several ways by which typhoid 
germs in a stream may get into foods. 5. How do flies carry ty- 
phoid fever germs? 6. How do these germs get into milk? 

Remember. 1. Typhoid germs come from people who have 
typhoid fever ; they are found in the urine and bowel discharges. 
2. No one should ever answer Nature's calls except in a place 
provided for that purpose. 3. No sewage should be allowed to 
go into any stream until all the germs in it have been killed. 



HOW TYPHOID FEVER GERMS ARE CARRIED 119 

4. Disease germs will live in running water fully as long as 
they will in still water. 5. The discharges from a single person 
may infect a whole city. 6. When typhoid fever germs get into 
milk, they grow very rapidly; hundreds of people have been 
given typhoid, fever by drinking the milk from a dairy where 
there was a single person sick with this disease. 7. People 
who have had typhoid often carry the germs for several months 
after they are well. 



Where 
hookworm 
disease 
prevails 



CHAPTER XXVI 

HOOKWORM DISEASE AND AMOEBIC DYSENTERY 

Hookworm disease and amoebic dysentery resemble 
typhoid fever in one respect, in that they, too are spread 
by the improper disposal of human excreta. 

Hookworm disease is found almost exclusively in trop- 
ical or subtropical climates„ In the United States it is 
rarely seen north of the Potomac and Ohio rivers. 



What the 

hookworm 

is 




Fig. 59. A full-grown hookworm, magnified; the short line shows 
the average length of the hookworm. 

This disease is not caused by a germ, as is typhoid fever, 
but by a worm from a quarter to half an inch long, and 
about as thick as a small hairpin. These worms get into a 
person's intestinal canal, and there lay their eggs, which are 
later given off in the bowel discharges. When these dis- 
charges are thrown on the ground, or are put into an open 
water-closet, they may be carried about by chickens, flies, 
and pigs. Then the eggs hatch in the soil and tiny hook- 
worms result. When human excreta are not properly dis- 
posed of, in climates where hookworm disease prevails, the 
soil becomes practically full of these little worms, and from 
the soil they find their w r ay into the bodies of the people. 



HOOKWORM DISEASE AND DYSENTERY 12 1 

There are two principal ways by which the hookworm How it 
may enter the body. One is through the mouth, which these body S thG 
worms reach in practically the same way as do typhoid 
fever germs. The hookworm may enter the body through 
the skin also. Some authorities state that the worm bores 
its way in ; but it is probable that it does not actually bore 
through sound skin, but enters at some point w T here there 
is a small break. 

After the worm gets through the skin, it is taken into Where it 
the blood and carried to the lungs, and from there it finds its b ody in 
way to the throat and is swallowed. It makes no differ- 
ence whether the hookworm is swallowed or enters the 
body through the skin; it finally reaches the intestinal 
canal, w T here it then makes its home. Sometimes thousands 
of these worms are found in a single person, and each one 
of them entered the body through the mouth or through 
the skin. The worms do not multiply in the body, and the 
eggs they lay never hatch until after they have left the 
body. 

When the hookworm gets into the intestinal canal, it How it 

sffccts the 
fastens itself to the wall and sucks the blood from it, at the pa tient 

same time giving off a poison that enters the blood of the 
victim. The loss of blood and the effects of the poison soon 
cause the person in whose body these worms are living to 
become weak, pale, and thin. He is not able to do much 
work, if any, and the result is that people suffering from 
this disease are often called lazy. They are not lazy ; they 
are sick, and many of them die. 

All this sickness and all these deaths might be pre- How hook- 
vented simply by the proper disposal of human excreta. worm dls ~ 
No human excreta should ever be put anywhere except into prevented 



122 PRINCIPLES OF PUBLIC HEALTH 

a properly constructed sewer or properly constructed privy. 
If this rule were always observed, both hookworm disease 
and typhoid fever would be abolished. 
Where Amoebic dysentery is another disease that is confined 

dysentery almost entirely to tropical and subtropical climates, though 
prevails cases sometimes occur in colder regions. 

How it is This disease, like typhoid fever, is caused by a germ that 

howl? may l eaves the body with the bowel discharges. The germ 
be prevented makes its way into the body in the same way that the ty- 
phoid germ enters; that is, it is taken in with food or 
drink. The various means by which this germ gets into 
our food are the same as those by which the typhoid germ 
gets in ; and the precautions that will prevent the spread of 
typhoid fever will also prevent dysentery. Amoebic dysen- 
tery kills a great many people in warm climates, though it 
does not kill as many as does typhoid fever. If it does not 
cause immediate death, it often leaves the patient very weak 
and sickly for months or years. 

Questions, i. In what climates are hookworm disease and 
amoebic dysentery commonly found? 2. In what respects do 
they resemble typhoid fever? 3. How does the hookworm 
enter the body? 4. Where do the hookworm eggs hatch? 
£. How can hookworm disease be prevented ? 6. What other 
diseases can be prevented by the same precautions ? 

Remember. 1. Typhoid fever, hookworm disease, and amoe- 
bic dysentery are all caused by the improper disposal of human 
excreta. 2. Most of the sickness that can be prevented is the 
result of dirty habits; if all people would keep clean and see 
that everything about them was kept clean, a great deal of sick- 
ness would be prevented and a great many lives would be 
saved. 



CHAPTER XXVII 

HOW SCARLET FEVER IS CARRIED 

There are certain diseases that we know to be communi- 
cable ( that is, "catching" ), but as yet we do not know 
the germ that causes them, and therefore we cannot tell 
just how they are carried about. We do know that they 
are transferred from one person to another; but not being 
able to locate the cause, as we can in the diseases of which 
we do know the germ, we cannot explain how it is done. 

Among the diseases of this class we find scarlet fever. How scarlet 
In one respect scarlet fever acts much the same as diph- ^ v {^ s ] -^ e 
theria. A person may have it and not be very sick, some- 
times hardly sick at all. At night a child may have a 
high fever, with a slightly sore throat, and the next 
morning he may feel perfectly well. The mother sup- 
poses that the fever was due to an " upset stomach," 
thinks no more about it, and sends the child to school. 
The next time the child takes a bath, he perhaps notices 
that the skin peels off over some parts of the body. This 
means that the high fever was due to scarlet fever, but the 
breaking-out (rash) was so fine that it was not noticed. It 
also means that all the children in the school have been 
exposed to the disease. These very mild cases are the 
most dangerous because so often they are not recognized. 

There are two things to be remembered in connection Why mild 

with these mild forms of scarlet fever, as well as of every d^ferous- 

other communicable disease. The first is that the same 

cause which produces a mild form of the disease in one 

child may produce its most severe form in another child. 

You can contract a mild form of the disease from exposure (l) For the 

to a severe case ; and you can contract a severe form from l^l eT ^^Q S 

123 



124 PRINCIPLES OF PUBLIC HEALTH 

exposure to a mild case. The character of the case to 
which you are exposed will give no indication of the form 
the disease will assume in your body. 
{2) For the The next thing to be remembered about the mild form of 
effects 6r scarlet fever is that, though the child may not be made 
very sick at the time, there may later be very bad results. 
A child who has had scarlet fever in such a mild form that 
he hardly knew he was sick, may, for a while, appear to be 
quite well; then suddenly he has an earache, and an 
abscess forms. This abscess is due to the scarlet fever 
germs w T hich have gone from the throat to the ear, and as a 
result the child may lose his hearing entirely. 

The child may not, perhaps, have an abscess, but after 
a time he may begin to lose flesh, and to grow pale. He 
does not care for his meals, does not care to play, says he 
is tired, and wants to lie still all the time. Finally his 
mother thinks it might be a good idea to have a doctor see 
him. The doctor examines his body carefully, and then 
asks for a sample of his urine. When he has examined 
this, he looks very serious and asks the mother when the 
child was sick last, and what the disease was. Perhaps she 
has forgotten all about the slight attack of fever, and the 
doctor must question her very carefully before she recalls it. 
At length it occurs to her, and then the doctor asks, " After 
this attack of fever, did you notice that the skin came off his 
hands and body?" She replies that she did, and then the 
doctor tells her that the child really had scarlet fever, and, 
owing to lack of care, he now has kidney disease. This is 
a very serious trouble, from which he may never recover, 
or, in case of recovery, he may always be weak and sickly. 
Even a mild attack of scarlet fever is not to be neglected ; 



HOW SCARLET FEVER IS CARRIED 



12$ 



How con- 
fusion of 
names 
causes mild 
cases to go 
undetected 



it is a severe and dangerous disease in its very mildest form. 
It not only kills a great many boys and girls, but it makes 
delicate in health for all their lives many of those who ap- 
parently recover. 

We often hear people 
speak of two diseases 
which they think are not 
scarlet fever. These two 
diseases are scarlatina and 
scarlet rash. Now scarla- 
tina is simply the scientific 
name for scarlet fever. 
Some doctors will tell you 
that you have scarlatina 
and that it is not exactly 
scarlet fever. A doctor 
who says this either is 
deceiving you or does not 
know any better. In either 
case, he ought not to be a 
doctor, for he lets children be exposed to a disease that 
is likely to kill many of them. It is the same with 
scarlet rash. This, too, is simply another name for scarlet 
fever. Changing the name does not change the disease, and 
you may call it scarlet fever, scarlatina, or scarlet rash — 
it makes no difference which; the disease is one and the 
same. 

Quarantine is the only way known for preventing the Why quar- 
spread of scarlet fever, as w T ell as of diphtheria. If every Pessary for 
case of scarlet fever were quarantined, we could soon scarlet fever 
stop this disease; but every case is, not quarantined, 




Fig. 60. One of the ways by 
which quarantine is broken. 



126 



PRINCIPLES OF PUBLIC HEALTH 



How break- 
ing quaran- 
tine shows 
selfishness 



because some of them are so mild that they are not 
recognized. 

Even when a case is quarantined, the people some- 
times neglect the instructions given, just as they do 
when there is a case of diphtheria. Then there are 
cases that are known to be scarlet fever but are not re- 
ported to the health officers, because the people do not want 
to be quarantined. They simply do not want to be put to 
any inconvenience themselves, and although this seems a 
very strange way for people to act, it happens very often. 
There are many selfish people in the world; there are 
even people who will not report a case of scarlet fever 
because to do so might prevent their going to a party. 
Selfishness is at the bottom of it. 

It is extremely important that a child should be abso- 
lutely free from all the little scales of skin which are thrown 
off after scarlet fever, before he returns to school or min- 
gles again with others. If there is a discharge from the nose 
or ears after the scales have disappeared from the skin, 
there is still danger of spreading the disease, for these dis- 
charges often retain the infection for many months. 



Questions, i. Give two reasons why mild cases of scarlet 
fever should be carefully treated. 2. Why is quarantine nec- 
essary? 3. How does selfishness lead people to spread 
scarlet fever ? 4. When is it safe to let a scarlet fever patient 
mingle with well people? 



Remember. 1. If you have scarlet fever and are not very 
sick, do not think that you will not be dangerous to others; 
severe cases sometimes come from exposure to the mildest 
cases. 2. Mild cases of scarlet fever often leave very bad re- 
sults, if the patient is not cared for. 3. Be very careful 



HO W SCARLET FEVER IS CARRIED 1 27 

until you- are entirely well. 4. Scarlatina and scarlet rash 
are nothing but scarlet fever; keep away from people who 
have them. 5. Quarantine is the only way by which we can 
prevent the spread of scarlet fever; there is no medicine that 
will prevent it. 6. People who violate quarantine regulations 
are both selfish and stupid. 



CHAPTER XXVIII 

MEASLES AND WHOOPING COUGH DANGEROUS 
DISEASES 

Measles is a disease in the same class as scarlet fever. 
We do not know the cause, but we do know that it is com- 
municable. 
Why measles Measles is usually not a severe disease; that is, it does 
avoided * not kill as many persons in proportion to the number of 
cases as does scarlet fever. It does, however, kill more 
people than most of us think; a great many little babies 
die of it. How often we hear mothers say, "I wish my 
children would have measles and be done with it." It 
would be very convenient if they could have measles in a 
mild way and "be done with it." The trouble is, that we 
cannot tell whether it will take a mild form, and, worse 
than this, we do not know when they will be done with it. 
If you should go into the children's wards of a large 
hospital, you would know why measles should be avoided. 
There you would hear the doctors questioning the mothers 
about the previous diseases of the little ones. You would 
be surprised at the number who replied, "He has not 
had anything but measles." Then you would hear the 
question, "How long since he had the measles?" "He 
was just over it when he was taken sick with this trouble." 
What is "this trouble"? Follow the doctor along from 
bed to bed and see the cases of pneumonia that started 
when the child "was just over measles"; see how many' 
cases of empyema (abscess in the chest) began just after 
the measles ended ; how many cases of abscess in the bone, 
how many cases of disease of the kidneys appeared after 

the child recovered from the measles. Then go down into 

128 



MEASLES AND WHOOPING COUGH 



129 



the eye and ear wards and see how many diseased eyes 
and ears have followed an attack of the measles. The 
children would not have had these troubles had they not 
first had measles. 

If you have measles, do not let others come near you, Necessity 
and do not think that, because you do not feel very sick, °^l^^ 

Whooping Cough Scarlet Fever Measles Smallpox 

4>856 4,309 4,302 74 



L 



L 



Fig. 61. Deaths in 1907 from four common communicable dis- 
eases reported to the United States Census Bureau. 

you can run about as usual. If you do not take good care of 
yourself, you may have some of the diseases that so often 
begin when children are getting over measles. Measles 
causes more deaths than is commonly supposed, especially 
among young children and very old people; and a great 
many children die of diseases which they never would have 
had if they had not first had the measles. Avoid people 
who have measles, and if you should get the disease, do 
not treat it as a slight thing, but consult your doctor at 
once. 

Whooping cough is much the same as measles in this Evil effects 
respect. It kills many children, and, in cases where it does co ^gh 
not kill them, their bodies become so weakened that they 
are liable to contract some other disease that may prove 
fatal. Avoid people who have whooping cough. 



130 PRINCIPLES OF PUBLIC HEALTH 

Questions, i. Why should people avoid measles ? 2. Why 
should one take care of himself when he has measles ? 3. Why 
is whooping cough to be avoided? 

Remember. 1. Measles is more fatal, especially among babies, 
than people realize. 2. Measles causes more diseases of the 
bones, ears, and eyes than any other communicable disease. 
3. Measles is not dangerous if properly cared for, but when 
neglected, it causes much suffering and many deaths. 4. 
Whooping cough causes almost as many deaths as does measles. 



CHAPTER XXIX 

HOW SMALLPOX IS PREVENTED 

We now come to the study of a disease, the cause of 
which has not been positively recognized. We know that it 
is very communicable; but we know also that there is abso- 
lutely no reason for anyone's ever contracting it, since 
there is a way by which it may easily be prevented. 

Something over a hundred years ago, smallpox was one Fatality of 

of the most fatal diseases known. It is estimated that ? m / llpo £ 

before the 

during the eighteenth century it killed over 60,000,000 discovery of 
! vaccination 

people. 

Up to the time when the Spaniards invaded Mexico, 
there had been no smallpox there. The Spaniards brought 
the disease with them, and historians tell us that out of the 
12,000,000 people living in Mexico at that time, at least 
6,000,000 died from smallpox. At that time the disease 
was considered fatal throughout the world; w T hen it broke 
out in a community, people fled without stopping to bury 
their dead. It was a rare thing to see a person not more 
or less disfigured by the marks the disease leaves on the 
face and body. 

To-day we find a very different condition. There are 
now fewer fatalities from smallpox than from almost any 
other communicable disease. During 1906 and 1907 only 
169 deaths from smallpox were reported from all over the 
United States to the Census Bureau at Washington. What 
has caused this marked falling off in the fatality of the 
disease ? 

During the time that smallpox w r as killing so many Discovery 
people, all the doctors were trying to find something that £ n aCCma ~ 
would cure the disease or that would prevent it. In the 

131 



132 



PRINCIPLES OF PUBLIC HEALTH 



Prevention 
of smallpox 
by vaccina- 
tion: 



(1) In the 
Franco- 
Prussian 
War 



latter part of the eighteenth century Dr. Edward Jenner, 
an English physician, noticed that milkmaids did not 
have smallpox as much as did people of other occupations. 
He also noticed cows with little sores on their udders that 
looked very much like the sores that come with smallpox. 
He therefore tried making on the arms of people sores 
just like those on the udders of the cows. He did this 
by taking a little of the matter from the sores on the 
cows and putting it into the scratches on the people's 
arms. After these sores had healed, the people who 
had been thus treated did not have smallpox. This 
simple practice has caused one of the most deadly dis- 
eases known to man to become one of the most easily 
controlled. 

Though it is well known that before the discovery of 
vaccination smallpox was a fatal disease, there are still 
some persons who say that vaccination has done nothing 
to reduce the mortality. When you learn some of the 
facts, you can judge for yourself whether or not vaccina- 
tion does prevent smallpox. 

During the Franco-Prussian War in 1870-71, the Ger- 
man soldiers were all vaccinated, and only a part of the 
French army was vaccinated. Smallpox broke out in the 
two armies. As a result, 6,000 of the French died from 
smallpox and only 278 of the Germans. In many instances, 
the German and the French soldiers were confined in the 
same hospitals, with exactly the same opportunities to 
contract the disease. But, you might ask, if vaccination 
prevents smallpox, how did it happen that there were any 
cases among the German soldiers? In order to prevent 
smallpox, vaccination must be successful; that is, it must 



HOW SMALLPOX LS PREVENTED 



133 



"take." We will tell you about different kinds of vacci- 
nation a little later. 

In Sweden we find strong evidence that vaccination {2) In 
prevents smallpox. Up to 1801, before vaccination was 
introduced into that country, the yearly death rate from 




Fig. 62. In Sweden, before vaccination, smallpox caused 2,050 
deaths per million population (represented by the large square). Since 
the introduction of vaccination the death rate has dropped to 2 per 
million population (represented by the two small squares). 

smallpox was 2,050 out of each million of the population. 
In 1 80 1 vaccination was introduced into Sweden, but the 
people were allowed to be vaccinated or not, just as they 
pleased. During the ten years ending with 181 1, the an- 
nual death rate from smallpox had dropped from 2,050 
per million of the population to 686 per million. Later, 
vaccination was made compulsory (that is, everybody in 
Sweden was obliged to be vaccinated), and in 1894 the 



134 



PRINCIPLES OF PUBLIC HEALTH 



(3) In the 
Philippine 
Islands 



U) In 

Gloucester, 

England 



death rate had dropped to only two deaths a year per mil- 
lion population. Is it merely a coincidence that this great 
falling off in deaths from smallpox came after vaccination 
was discovered, or was it due to vaccination ? 

Before the Philippine Islands were occupied by the 
Americans, vaccination was very little practiced, and a 
large percentage of the deaths in those islands was caused 
by smallpox. In 1897 smallpox caused about 40,000 deaths. 
A few years later the Americans enforced vaccination among 
the inhabitants of the Philippines, and the result was that 
in 1907 there were only 304 deaths from smallpox. There 
has been practically no quarantine for smallpox and no 
disinfection ; the only cause of the suppression of the disease 
in the Philippine Islands is vaccination — nothing else. 

In Gloucester, England, there used to be a great many 
people who did not believe in vaccination, though it is 
doubtful if they themselves could have explained why they 
did not. They seem to have been much like the man who, 
when asked, "What do you think of this?" replied, "I 
don't know anything about it, but I am against it." In 
1890 Gloucester had a population of 42,000 people, most 
of whom had never been vaccinated. In the latter part of 
1895, smallpox broke out. Quarantine was strictly carried 
out, but the disease continued to spread. As the people saw 
the number of victims rapidly increasing, many of them 
concluded that they had rather be vaccinated than have 
smallpox, even though they did not really believe in vac- 
cination. By the first of April, 1896, over 36,000 people 
had been vaccinated in Gloucester, and by the first of 
August there was not a case of smallpox in the city. But 
what had happened in the meantime? There had been 



HO W SMALLPOX IS PREVENTED 1 35 

i, 979 cases of smallpox; a very large amount of money had 
been expended in quarantining; hundreds of persons had 
been disfigured for life; and 439 lives had been lost. 
And all this simply because the people did not believe in 
vaccination. 

Quarantining smallpox is a most expensive luxury, 
which may possibly retard the progress of this disease, but 
was never known to check an epidemic of it. Every 
epidemic of smallpox during the last one hundred years 
has been checked by vaccination. 

There are certain diseases which you are not likely to Why some 
have more than once ; one attack protects against another. not return 
Why and how does one attack of a certain disease protect 
against another? When a person is taken sick with one 
of these diseases, the cells of his body immediately begin 
to make a substance called antitoxin. We learned some- 
thing about antitoxin when we were studying diphtheria. 
In diseases like scarlet fever, measles, and smallpox, in 
which one attack protects against another, the antitoxin 
that is formed in the body when you are sick stays there 
for a long time, in some cases as long as you live. While 
this antitoxin is present in the blood, the cause of the dis- 
ease cannot live in the body; hence you cannot have the 
disease again. After some diseases this antitoxin seems to 
disappear from the blood in a short time; after others, it 
seems to remain for several years ; and after still others it 
remains as long as you live. After diphtheria it stays in 
the blood only a short time, so that one may have diph- 
theria a second time within a few years. Some people 
have smallpox, measles, or scarlet fever a second time, but 
with most people these diseases never return. 



136 PRINCIPLES OF PUBLIC HEALTH 

If we knew how to make the cells of our bodies produce 
this antitoxin and keep it stored up in the blood all the 
time, we should never have any of these diseases. But in 
many cases we do not know how to cause the cells to manu- 
facture this antitoxin. However, in one or two diseases 
we do know how to persuade them to make the antitoxin, 
and the one in which we know how T to accomplish this best 
is smallpox. This is just what is done by vaccination. 
How vacci- The object of vaccination is to put the cells of the body 
vents small- to work making antitoxin. To do this, it is necessary to get 
P° x some of the toxin into the body. We want to get in just 

enough to make the cells work, and no more. Therefore we 
make a very small scratch, and put into it some of the 
vaccine which contains the toxin of smallpox. It is im- 
possible to have these germs in your body and not be 
affected by them to some degree. If you did not feel a 
little sick, the cells would not be making antitoxin, for the 
thing that makes you sick is what makes the cells go to 
work. But this sickness is only a matter of a day or two, 
and after the cells have made the antitoxin, it will stay 
in your body a long time, longer in some cases than in 
others. 

Some people, after they have once been vaccinated, can 
never be successfully vaccinated again; neither can such 
people ever have smallpox. Most people, how r ever, can be 
successfully vaccinated every five to seven years, and there 
are a few people who will "take" if vaccinated every year 
or two. These conditions indicate the length of time that 
the antitoxin of smallpox will live in the bodies of these 
different persons. If vaccination, properly performed, does 
not take, the person is not in a condition at that time to 



HOW SMALLPOX LS PREVENTED 137 

catch smallpox; and if vaccination, properly performed, 
does take, it is positive evidence that if this person had been 
exposed to smallpox, he would have taken the disease. 

It is frequently asked, "How long will vaccination pro- Necessity of 
tect against smallpox?" You can no more answer this vaccination 
question than you can tell how long the antitoxin will live in 
the blood of any particular person. The only safe thing to 
do is to be vaccinated every few years, and if smallpox is 
present in your community, get vaccinated every year until 
the vaccination takes. If it takes, it shows that you were 
in a condition to catch the disease ; and if it does not take, 
you may feel safe from smallpox for a while, at least. 

Questions, i. Why was smallpox formerly more widespread 
and more often fatal than it is now? 2. Tell of the discovery 
of vaccination. 3. Give instances to show the influence of 
vaccination on smallpox epidemics. 4. Why must there be re- 
peated vaccinations? 5. Show how vaccinating for smallpox 
is like taking antitoxin to prevent diphtheria. 

Remember. 1. Before the introduction of vaccination, small- 
pox was one of the most dangerous diseases known. 2. All 
evidence of history tends to show that vaccination has caused 
smallpox to become a very mild disease and a comparatively 
rare one. 3. Successful vaccination repeated at proper inter- 
vals will prevent smallpox. 4. Vaccination must be repeated 
because we do not know just how long the material developed 
in the body from a single vaccination will last. 



CHAPTER XXX 



WHY VACCINATION SOMETIMES SEEMS A FAILURE 



What con- 
stitutes a 
successful 
vaccination 



Some pre- 
tended vac- 
cinations 



How does it happen that those who have been recently 
vaccinated sometimes have smallpox? It is successful 
vaccination that prevents smallpox, not recent vaccination ; 
there is a vast difference between the two. A successful 
vaccination is one that results in a sore identical with the 
sores of smallpox. Such a sore is secured only as a result 
of the action of the germs that cause smallpox. 

If the arm is red from the shoulder to the wTist and so 
swollen that you cannot use it for w r eeks, it does not neces- 
sarily mean that you have had a successful vaccination. 

Such arms are not the result of vaccination itself, any 
more than a railroad wreck is the result of the fact that 
there is steam in the engine. The railroad wreck is caused 
by carelessness on the part of some operator, and the badly 
inflamed and swollen arm is due to lack of care or knowl- 
edge on the part of the vaccinator or the person 
vaccinated. 

A fly blister is not a successful vaccination. Such a state- 
ment may not seem necessary, until you hear this story. 
A man showed a sore on his arm, asserting that it was a 
successful vaccination. He was told that it was nothing but 
the result of a blister, and not vaccination, and that the work 
had been done by putting a small bit of blistering plaster 
on his arm. He admitted this to be the fact, and said that 
the " doctor" who did it told him that it was a new way of 
vaccinating. The doctors who say that vaccination will 
not prevent smallpox belong to the class who use fly blisters 
and call them vaccinations. When the patient gets small- 
pox, those who are opposed to vaccinations say that here 

138 



VACCINATION SOMETIMES SEEMS A FAILURE 1 39 



is an illustration of their claim that vaccination will not 
prevent smallpox. 

Some people who honestly think they were vaccinated 
have smallpox. There are sometimes instances in which a 
person recently vaccinated with apparent success neverthe- 
less contracts smallpox ; there are still other cases in which 
the disease develops after a vac- 
cination that would not take. Here 
is an example: 

A doctor vaccinates a child in 
the usual manner. At the end of 
four or five days, the dressing is 
taken from the arm, and the only 
thing to be seen is a little black 
scab. The child scratches this off. 
In a few days the spot becomes 
red and a small abscess forms, re- 
sembling a smallpox sore. Natur- 
ally, this is taken for a completely IG " 3 

■ . l J arms 

successful vaccination, but it is not f ec ted 

really so. When the child scratched 

off the scab, the vaccination wound was nearly healed, and 
the little abscess was caused by some very mild pus germs, 
which were under the finger nails with which he scratched 
the w T ound. The abscess was in no wise connected with 
the vaccination, but was simply such an infection as a child 
might get at any time that he scratched his arm. No one 
has ever claimed that such an abscess will prevent small- 
pox any more than that a boil will prevent it. 

A successful vaccination will prevent smallpox. The 
length of time for which it will prevent the disease varies 




How vaccinated 
are sometimes in- 



140 



PRINCIPLES OF PUBLIC HEALTH 



A sore arm 
not always 
due to suc- 
cessful 
vaccination 



Cause of 
sore arms 



in different individuals. Some it will protect only for a 
year or two, while in others it will last through life. 

Dr. H. W. Bond, Health Commissioner of St. Louis, 
Missouri, states: 

"The experience of this department, based on the obser- 
vation of thousands of cases, is that a well-pitted mark 
gives at least ten years' immunity. We have never seen a 
case of smallpox in a person with a well-pitted scar less 
than ten years old — that is, the scar less than ten years 
old." 

One of the strongest objections made against vaccination 
is that the arm sometimes becomes very sore from it. This 
is true, but the sore arm is not a common occurrence and is 
never caused by vaccination properly performed. There is 
always some cause for the bad arm besides the vaccination. 

The usual cause of a bad arm is improper vaccination; 
this means the lack of proper precautions on the part of 
the person who does the vaccinating. Years ago, before 
vaccination was performed with the great care which is 
given it to-day, bad arms could not be prevented; but 
to-day the cause of the trouble is not the vaccine, but the 
vaccinator. Sometimes a father thinks he will save a dollar 
by vaccinating his child himself, and he is likely to injure 
the child by attempting to vaccinate him without taking 
antiseptic precautions. The same surgical preparations 
must be made for a vaccination as for an operation. If 
this is not done, a bad arm will result, not because of the 
vaccination, but because of the negligence of the vaccinator. 

Never allow any person, doctor or otherwise, to vaccinate 
you until the skin surface has been well washed with soap 
and water, rinsed clean, and wiped off with alcohol. See 



VA CCINA TION SOME TIMES SEEMS A FA IL URE 1 4 1 

that the vaccine is fresh and has been properly kept. When 
it begins to "take,*' keep the spot absolutely clean and 
covered with a clean cloth, renewed daily. Never scratch 
or rub it. These precautions will prevent the dreaded sore- 
ness of the arm. 

The person operated on is himself often responsible for How people 

themselves 
the bad arm. A careful doctor will put a dressing on the* infect their 

arm, after he has supplied the vaccine, and will tell you to arms Wlth 
' rr ' # J pus germs 

let that dressing alone, for he wishes to take it off himself. 
About the third or fourth day after the vaccination, your 
arm begins to itch. Possibly you have forgotten what 
the doctor told you; at any rate, you pay no attention to 
directions and take the dressing off to scratch the arm. 
When you scratch the wound, you introduce pus germs into 
it, and you have no reason to expect anything but a sore 
arm. In this case, it is not the fault of the vaccinator or of 
the vaccination ; it is your own fault. Never touch a vac- 
cination sore ; in fact, it is dangerous to touch any sore. 

Questions. 1. How is a successful vaccination determined? 
2. What are some pretended vaccinations ? 3. Mention some 
of the things that cause bad arms after vaccination. 

Remember. 1. A successful vaccination causes a sore identi- 
cal with the sores that result from smallpox. 2. A fly blister 
is not a vaccination in any sense of the word. 3. A very sore 
arm does not result from a properly performed vaccination, but 
from carelessness on the part of the vaccinator or the person 
vaccinated. 



CHAPTER XXXI 



CONSUMPTION, THE GREAT WHITE PLAGUE 



Why con- 
sumption is 
called the 
Great White 
Plague 

Consump- 
tion more 
destructive 
than war 



Prevalence 
of tuber- 
culosis 



Tuberculosis, or consumption, has been known for many 
centuries. It was known long before Rome was ever heard 
of. Hippocrates, a Greek physician, studied it, and said 
that if it were treated in its early stages, it could be cured. 

Tuberculosis is called the Great White Plague. It is 
called the Great Plague, because it kills more people than 
does any other one disease; the White Plague, because 
people who suffer from it become so pale and white. 

It is estimated that nearly 200,000 people die from tuber- 
culosis every year in the United States. This means that 
in this country there is one death from consumption every 
two minutes and thirty-six seconds. Is it not fearful to think 
of nearly 200,000 people dying every year, in the United 
States alone, from a disease that we know can be pre- 
vented? Do you not think that we ought to do every- 
thing we can to prevent this disease from spreading? 

During the Civil War 205,070 soldiers were killed in both 
armies. This war lasted four years. During the same 
length of time there were 640,000 deaths from tuberculosis 
in the United States. This means that consumption killed 
over three times as many people as were killed during the 
same length of time in the Civil War. In some parts of the 
country one out of every seven deaths is caused by this 
disease, but the average throughout the country is one 
death out of every ten. 

There are more than 700,000 people sick from tubercu- 
losis every year in the United States alone. Of this num- 
ber nearly 200,000 die every year. Tuberculosis is a disease 
that can be prevented. It may take a long time to get rid of 



142 



CONSUMPTION, THE GREAT WHITE PLAGUE 1 43 

it, but it can be abolished. When you think of all the 
people that are sick from tuberculosis, and of all those 

who die from it every year, you will surely 

want to do all you can to help prevent 

this suffering and death. 

When people speak of consumption Tuberculosis 

they usually mean tuberculosis of the of var ious 

lungs ; but tuberculosis is not confined p ar * s ° f the 

body: 
to the lungs. The germs that cause 

tuberculosis may attack any part of the 
body, and from one part may go to 
other parts, setting up a growth wher- 
ever they go. 

I Tuberculosis of the throat is a com- (1) Of the 
mon form of the disease. When the oa 
germs of tuberculosis settle in the 
throat, they destroy the tissues very 
rapidly and, as a rule, kill the patient 
much more quickly than they do when 
they start in the lungs. 

the' aiooTdeaih! Another frec l uent form of tuberculosis gMM the 
from tuberculosis in occurs in the knee; this is popularly 
the United States called "white swelling." It quickly de- 
during four years gt ^ knee -^ and resuhs {n a stJff 

with the 205,070 . _ , , , 

deaths in the Civil le g- The growth may stop there, but 
War. more often it extends from the knee to 

other parts of the body. 
Often we see a little boy or girl wearing one shoe with a 
sole much thicker than the other. This is because one leg 
is shorter than the other, and we notice that the shortened 
leg is deformed as well. This condition sometimes results 



144 



PRINCIPLES OF PUBLIC HEALTH 



{3) Of the 
spine 



from an injury, but it is far more likely to be caused by 
tuberculosis of the hip joint. 

Again we see boys and girls with diseases of the spine, 
so that they have " hunch backs" or are twisted to one side. 

















^i^V ^tok. wsT* ^'^ 


j^f^^iiHi 






A *fcw 


ft'*ii^BLjfefe#yBfc. 


' ;(i H : ' 


fc^S 




- TwSy 


^»|KR?^'" ; -'lBai#":c 


g^^^^gS 
















n h ^mx 


^f^^^^^^V 


fTTTt^-^/V^SfTl 






/TjfJw 


ff\^^^ife_^7 


P^gl 






m^rl 


v^C^^*^ i 








/M^y 


/^^f^^fv- 






™ 


o 



Fig. 65. One of the effects of tuberculosis. 



(4) Of the 
glands 



(5) Of the 
stomach 



These conditions result from tuberculosis of the bones of the 
spine. 

Sometimes we see children and grown people with swell- 
ings on their necks. These swellings may look smooth, but 
they feel as if they were made up of little bunches of grapes 
or plums under the skin. They are almost always due to 
the growth of the germs that cause tuberculosis of the little 
glands of the neck. 

Any one of the other glands of the body is just as liable to 
become affected by tuberculosis as are the glands of the 
neck. Tuberculosis of the stomach or bowels is not at all 
uncommon. 

The germs of tuberculosis are likely to attack any of the 
tissues of the body, especially if the cells composing these 
tissues are for any reason weakened so that they cannot do 
the work required of them. When the tuberculosis germs 



CONSUMPTION, THE GREAT WHITE PLAGUE 145 

grow in tissues, the tissues finally break down and an ab- 
scess forms. A tubercular abscess is sometimes called a 
"cold abscess." 

All such abscesses finally break and an open sore results. 
The matter that comes from the open sore and from the ab- 
scess when it is first opened is full of the germs that cause 
tuberculosis. If this matter is allowed to become dry, the 
germs are blown about in the dust. Then other people may 
inhale them or take them into their bodies through the 
mouth or skin and thus contract consumption. 

Until a few years ago it was generally believed that con- The old 

sumption was inherited. That is, it was thought that beIief that 
r 7 ° consump- 

children whose father or mother had consumption were tion is in- 
born with the disease. Even to-day many people hold to this 
idea, because they have not studied or learned of the dis- 
coveries made in recent years. These people still believe 
that if a child's father or mother dies of tuberculosis, the 
child will die of tuberculosis, too, no matter how careful he 
may be or how much of a fight he may make against it. 

It is true that many people whose parents have died of 
consumption also die from this disease; but this does not 
prove that they were born with consumption. It merely 
shows that they had a good chance to catch the disease by 
being continually with some one who had it. It is also true 
that a great many people die from consumption whose 
parents did not have it. If consumption is an inherited 
disease, where did these people get it? 

About thirty years ago, Dr. Robert Koch discovered How the 
that all consumptives have in their sputum a long, slender fSSi? 
germ which he called the tubercle bacillus. Some of these losis was 
germs he injected into guinea pigs, and he found that they 



146 



PRINCIPLES OF PUBLIC HEALTH 



Evidence 
that con- 
sumption 
is not in- 
herited 



Evidence 
that con- 
sumption is 
a house 
disease 



caused the pigs to have consumption. Then he made 
many other experiments, and proved beyond question that it 
is this very germ that causes tuberculosis, and that no one 
has consumption unless he has this germ in his body. 

Then the question arose, "Is the baby whose parents 
have consumption born with this germ in its body?" This 
question could not at first be answered; but tests were 
made by taking the children of consumptive parents away 
from their parents, and keeping them in homes where there 
were no consumptives. It was found that these babies did 
not develop the disease. From these and many other tests, 
it has been proved that consumption is not inherited, and 
that the reason the child of the consumptive so often has 
consumption is because he lives with people having the 
disease. 

Consumption seems to be confined to certain families, 
and this has led many people to think that the disease is 
inherited, regardless of the proof that it is not. When we 
carefully study the facts in various cases, we find that the 
disease is not confined to a certain family, so much as it is 
to the house in which the family lives. 

The record of a single house will illustrate how tubercu- 
losis sticks to the house rather than to the family. From 
1880 to 1 90 1, a particular house was occupied by a father, 
mother, and six children, of whom four died of consump- 
tion. From 1902 to 1903 the house was occupied by an- 
other father and mother with eight children. They moved 
away because of the great amount of sickness in the family. 
At present this father and one of his children have tuber- 
culosis. In 1904 the house was occupied by still another 
family, consisting likewise of a father, mother, and eight 



CONSUMPTION, THE GREAT WHITE PLAGUE 147 



children. Now it is known that four of the children have 
tuberculosis, and it is feared that three others have also 
contracted the disease. In 1905 a son of the first occupant, 

with his wife and two 
children, returned to live 
in the house. The father 
of this family died of tu- 
berculosis. Up to 1906 
the total results from this 
house, scattered through 
four families, were as 
follows: five deaths, six 
cases in people still living, 
and three suspected cases. 

When the consumptive Why con- 
coughs, he sends fine drop- [ s 7 h ^ u n se 
lets of moisture into the air. disease 
These droplets contain the 
germs that cause tubercu- 
losis. The moisture evap- 
orates and the germs are 
left sticking to the floors, 
the walls, the curtains, 
and the furniture of the 
room. When the room is sw r ept or dusted, the germs are 
stirred up with the dust and people inhale them. The 
germ that causes consumption will live for a long time 
in a house ; you cannot see it, but it is there. Wherever 
a consumptive has lived, he has left the germs of this 
disease behind him. How to 

If a house in which a consumptive has lived is thoroughly houses 




Fig. 66. The constant danger of 
infection in railway cars, where 
germs can live as well as in a 
house. 



148 PRINCIPLES OF PUBLIC HEALTH 

disinfected, all the germs he left there will be killed. Scat- 
tering disinfectants about a room does no good. The only 
proper way to disinfect is to close the house, for if the dis- 
infectant is strong enough to kill the disease germs, no 
human being can stay in the house while it is being 
used. Disinfecting should be done by the health officer, 
because he knows how much disinfectant is needed 
to kill every germ in the house and how it should be 
used. 
Fraudulent Sometimes you will see an advertisement saying that cer- 

tants ta ^ n disinfectants will kill the germs of disease but will not 

affect the people. Always remember that any disinfectant 
that is strong enough to kill the disease germs will also 
kill human beings, and do not be fooled by such adver- 
tisements. 

Never move into a house that has been previously occu- 
pied, until the house has been disinfected. Do not take it for 
granted that the people who lived there before had no 
communicable disease. Do not take the word of the agent 
or of any one else that there has never been sickness in 
the house. People sometimes have tuberculosis without 
knowing it; people sometimes have tuberculosis or other 
communicable diseases without telling of it. 

It does not cost much to disinfect a house, and if the dis- 
infection is properly done the disease germs will be killed. 
"An ounce of prevention is worth a pound of cure." Try 
to convince your father that by having the new home dis- 
infected he may save not only doctor's fees, but perhaps 
the lives of himself and his family. 

There are a great many things that boys and girls can do 
to help fight this disease. This "scourge" can be wiped 



CONSUMPTION, THE GREAT WHITE PLAGUE 149 

out ; but if the boys and girls do not help in this great work, 
it will never be done. 

Questions, i. Why do people call consumption the Great 
White Plague? 2. What is the annual death rate from con- 
sumption in the United States? 3. Compare the fatality from 
consumption with the number of soldiers killed during the 
Civil War. 4. What amount of illness in the United States is 
due to consumption? 5. Describe at least four forms of 
tuberculosis. 6. What determines the part of the body in which 
the germ of tuberculosis grows? 

Remember. 1. Tuberculosis and consumption are the same 
disease. 2. This disease kills more people than war, although 
it might be prevented. 3. Tuberculosis is not confined to the 
lungs but may attack the tissues of any part of the body. 4. 
Consumption is not inherited ; it is a house disease rather than 
a family disease. 5. A house should be disinfected by the 
health officer before it is occupied by a new tenant. 



CHAPTER XXXII 



HOW CONSUMPTION IS SPREAD AND HOW PREVENTED 



How tuber- 
culosis 
germs leave 
the body: 



[1) In dis- 
charges 
from sores 



The sputum (spit) of the consumptive and the discharges 
from tubercular sores contain the germs that cause tuber- 
culosis. Sometimes these germs are so numerous that thou- 
sands of them would be found clinging to the point of a 
needle dipped into the sputum or discharges from a patient. 
When the consumptive coughs, he sends into the air many 
of the germs that cause tuberculosis. 

We cannot kill the germs while they are in the body of the 
consumptive ; but we can kill them after they have left the 
body, by seeing that none of the sputum or discharge from 
tubercular wounds or sores is allowed to become dried and 
blown about as dust. 

When the discharge from a tubercular sore becomes 
dried and blows about with the dust, the germs are inhaled 
into the lungs of other people, or fall into other sores and 
cause them to become tubercular. Since this is one of the 
most frequent ways by which this dread disease is spread, 
you will say at once, " Why, every particle of matter from a 
tubercular sore ought to be burned, so that there would be 
no possibility of the germs being scattered.' ' This of 
course ought to be done, but this is not enough. 

People sometimes have consumption and are not aware 
that they have it. Others may have tubercular sores and 
not know them to be such. Any sore, whether it is tuber- 
cular or not, contains disease germs. They may not be the 
germs of tuberculosis, but even the least dangerous of them 
is the germ that causes pus (matter). 

Since we are trying to get rid not only of the germs that 
cause tuberculosis, but also of the germs that cause all 



150 



sputum 




CONSUMPTION SPREAD AND PREVENTED 151 

communicable diseases, it would be better to say, "All 
discharges from any. sore should be burned immediately/ ' 

When people spit on the sidewalk or on the floor, the (2) In the 
sputum will of course become dry. Sometimes a lady 
drags her dress through the sputum on the sidewalk or on 
the floor; it sticks to her dress and she takes the germs 
home with her. The sputum of the con- 
sumptive is loaded with the germs that 
cause tuberculosis, and if this sputum is 
allowed to be blown about with the dust, 
people will inhale it and thus get the 
germs into their lungs. Certainly the 

consumptive should never spit on the FlG ' 6 /- A s P utum 
1 . . cup of waterproof 

sidewalk or on the floor, or in the mine, pasteboard 

workshop, or in any place where the 
sputum may become dry and form dust. Of course he 
should not fill the air about him with germs by coughing 
into it; everybody knows that. 

But no man or woman, boy or girl, should ever spit on Why every- 
the floor or sidewalk. In the first place it is bad manners, ^^carefu^ 
No person does this who is well brought up. In the second about spit- 
place, w r e must remember that the consumptive does not coughing 
like to have others know that he has consumption; this 
feeling is a part of the disease. If you expect the con- 
sumptive to refrain from spitting on the floor or sidewalk, 
you must help him by your example. You cannot expect 
him to be the only one to hunt up a cuspidor, when you 
yourself are spitting on floor or sidewalk. If you expect 
the consumptive to take the precaution necessary to pro- 
tect you from this disease, you must take the same pre- 
caution yourself. 



152 



PRINCIPLES OF PUBLIC HEALTH 



How to avoid 
spitting on 
the floor or 
sidewalk: 



CO By 
using paper 
napkins 



{2) By 
using 
pocket 
cuspidors 



(3) By hav- 
ing public 
cuspidors 




Fig. 68. A pocket 
cuspidor. 



In the matter of coughing, the same rules hold true. 
If you expect the consumptive to hold a handkerchief be- 
fore his mouth when he coughs, you must 
do the same. 

Since it is not right that the consump- 
tive should spit on the floor or sidewalk, 
it will naturally be asked, " What is the 
consumptive to do with what he coughs 
up?" 

At a very small cost he can buy paper 
napkins and envelopes which have been 
treated with paraffin to prevent moist- 
ure going through them. If every one 
with a cough or with any such trouble as catarrh, which 
makes him want to spit frequently, would carry a supply 
of these paper napkins and paraffin envelopes, he would 
always have a suitable place in which to spit. When you 
cough up anything, spit into one of these little napkins, 
put the napkin into the envelope, and when you get home 
burn the whole thing. 

There are other conveniences which can easily be carried 
in the pocket, called pocket cuspidors. Some are made of 
thin cardboard, treated wdth paraffin, and filled with 
cotton to hold all the moisture of the sputum; others are 
made of glass, shaped like a bottle, with a wide mouth. 
Those made of cardboard should be burned as soon as 
possible and the glass ones should be thoroughly washed 
with boiling water. 

In some cities cuspidors have been placed at the edge 
of the sidewalk in an effort to lessen the spread of disease 
caused by spitting. These cuspidors have a stream of 



CONSUMPTION SPREAD AND PREVENTED 153 



water running through them constantly and are connected 
with the sewer. They are so made that they cannot easily 
be kicked over or upset, and they are placed on stands just 
high enough to make it easy to spit into them. If properly 
made, they are not unsightly. Would it not be a good thing 













SS§S§w 






5g£&J 


\_J0FJ\_ _ ~3^j??!$'_ 


■i^^^P^^t \ ~~ 




/ j^-?t^ES^2S 


: 5fe^^^3*l^ j 


^jfe^Sg^S 








Fig. 69. The common drinking 
cup — a fruitful source of in- 
fection. 



Fig. 70. The individual drink- 
ing cup — each cup clean and 
free from disease germs. 



if your town would put such cuspidors on your streets, and 
if the merchants would put them into their stores ? Every 
office, every workshop, every store, every railway and 
street car should be provided wdth cuspidors. 

We know T that the substance which people cough up How con- 
when they have consumption contains the germs that cause f^^^ad 
this disease. When they spit this matter out, many of the from the 
germs stick to the lips. This is true not only of consump- 
tion, but of the germs of other diseases, such as diphtheria, 
measles, and scarlet fever. 

When there are disease germs on the lips, it is impossible U) By drink- 
for a person to drink and not leave some of the germs 



154 



PRINCIPLES OF PUBLIC HEALTH 



sticking to the edge of the cup or glass. If the germs of 
disease are in the mouth, every time that the person suffer- 
ing from this disease drinks from a cup, he leaves some of 
the germs on the edge of it. The next person to drink 
from that cup may get the germs into his mouth. 



(2) By put- 
ting pencils 
into the 
mouth 



{3) By the 

common 

bite 




Fig. 71. A sanitary drinking fountain for public places. 

Always avoid drinking from a cup or glass from which 
another person has been drinking. You can never tell 
who may have disease germs in his mouth, or when you 
may get them on your lips by drinking from the same cup. 
Each individual should have his own cup and should never 
let any one else drink from it. 

When you put the point of your pencil into your mouth, 
you will leave germs on it just as you do on the edge of a 
cup when you drink. Never put your pencil into your 
mouth; never use any other person's pencil; never trade 
pencils. 

Sometimes we see a child giving his friends a bite of his 
apple or candy or cake. Of course when disease germs are 
in the mouth of the one who takes a bite, the germs will be 



CONSUMPTION SPREAD AND PREVENTED I 55 

left on the apple, candy, or cake. By no means should a 
boy or girl be selfish, but if you have something to share 
with your friends, break it or cut it into pieces. Never 
take into your mouth anything from which another person 
has taken a bite. 

Milk that comes from consumptive cows may contain the How tuber- 
germs that cause tuberculosis. When you drink the milk cauYe^oin- 
from such cows, you take these germs into your body, sumption 
They find their way from the stomach and intestine into 
the blood, and there they travel about until they find a spot 
where the cells are dead or are not doing their work prop- 
erly. When they find such a place, they settle down and 
begin to grow ; and the first thing you know, you will have 
tuberculosis in that part of your body. Sometimes the 
germs do not have to go out of the stomach or intestines to 
find a favorable opportunity to take hold and grow. When 
this happens, we have consumption of the bowels. 

One cannot tell by looking at milk or by tasting it 
whether or not the germs of tuberculosis are present. They 
do not make the milk sour; neither do they make it look 
different from pure milk. 

One cannot tell by looking at a cow whether or not she 
has tuberculosis. Sometimes a cow will have tuberculosis 
and yet look very healthy. There is, however, a way by 
which we can tell when a cow has this disease, no matter 
how healthy she may look. This is what is known as the 
tuberculin test. 

If a little tuberculin is injected under the skin of a cow How to de- 
that has tuberculosis, it will make her have a fever and cu i os ^ ^~ 
appear sick for a day or two. If she is free from tuberculo- a cow 
sis, it will not make her sick at all. 



156 PRINCIPLES OF PUBLIC HEALTH 

It would seem as if all people who sell milk would want 
to know whether their cows have consumption so as not to 
run any risk of conveying the disease to their customers. 
Some of them do take this precaution, but a great many of 
them do not want to go to this trouble. Sometimes you will 
hear them say, " Oh, I do not believe in this tuberculin test." 
They do not want to believe in it because they know that 
the cows, if tested and found to have tuberculosis, will 
have to be killed. 

The reason that dairymen sell us milk from tubercular 
cows is the same that makes the man with scarlet fever in 
his house fail to tell the health officer about it; the same 
that makes the butcher buy and sell meat from diseased 
cattle; the same that makes some people absolutely re- 
gardless of the welfare of others — it is selfishness. 

Questions, i. How does a patient give off tuberculosis 
germs? 2. Why should even well people refrain from spitting 
in public? 3. Why should the sputum be taken care of? 
4. Why should we avoid the common drinking cup ? 5. What 
is the danger from putting pencils into the mouth? 6. Is it 
safe to use another person's pencil ? 7. What is the best way of 
sharing food? 8. How can one be protected from tubercular 
milk? 

Remember. 1. The sputum and discharges from all sores 
should be immediately burned or disposed of in such a way that 
they cannot become dry and be blown about as dust. 2. Con- 
sumption may be contracted by the use of the common drink- 
ing cup, or by putting into your mouth such things as pencils 
and coins. 3. The milk from a cow suffering from consumption 
contains the germ of tuberculosis. 4. A cow may have tuber- 
culosis and not appear to be sick. 5. The only way to deter- 
mine whether a cow has tuberculosis is by using the tuberculin 
test. 6. Every milch cow should be tuberculin tested. 



CHAPTER XXXIII 

HOW CONSUMPTION IS CURED 

When people first get consumption, they seldom realize Consumption 
that they are seriously sick. Most of them think they recognized 
have a bad cold, or are overworked, or that they have been early 
staying too closely in the house. Often they will not even 
see a doctor until they are so sick that the doctor cannot do 
much for them. 

When you have a slight cough that " hangs on"; when 
you feel feverish every afternoon; when you are short of 
breath ; when you get tired very easily ; when you do not 
feel like eating anything except candies and cakes — then 
you should think of consumption. These are not all the 
signs, but they are enough to make you go at once to a 
doctor. 

A long time ago the doctor would have felt badly if he 
had been obliged to tell you that you had consumption; 
but now he knows that if you go to him early in the disease 
and follow his directions, you will get well. 

When the doctor finds that a person has consumption, the How con- 
first thing he orders is rest. By this he means absolute rest, cured ^ * S 
He does not mean that the patient can go to school or to (0 B y rest 
the office part of the day and rest the remainder of the day. 
The doctor will want to watch him constantly. Then 
there comes a time when he must begin to take a little exer- 
cise ; the doctor tells him just how much exercise to take, 
and just what form of exercise is best for him. 

The consumptive must have plenty of fresh air all the (2) By fresh 
time ; he must be out-of-doors as much as possible. You 
will wonder how the doctor expects him to be out-of-doors 
when he has been told that he must have absolute rest. 

iS7 



air 



i 5 8 



PRINCIPLES OF PUBLIC HEALTH 



(3) By sun- 
shine 



Later we will show you how one can practically be out-of- 
doors and yet at the same time be in bed. 

Sunshine will kill the germs of any disease more quickly 
than almost anything we know of, and a consumptive must 
have all the sunshine that he can get. Of course it cannot 
get into the body to kill the germs, but it strengthens the 



(4) By nour- 
ishing food 




Figs. 72 and 73. Living outdoors in cold weather. 

cells of the body so much that they can fight with just that 
much more energy. 

Nothing is more important than pure food in building 
up the body and in making heat and power. In consump- 
tion the food that is stored up in the body burns itself up 
very fast. The consumptive must therefore take not only 
the food needed to supply the usual demands of the body, 
but enough to make something extra for the disease to 
burn up without drawing on the reserve fund stored in 
the body. In order to do this, he will have to eat a great 
deal, and what he eats must be of the kind that makes the 
best building material and the most nourishing material. 



HO W CONSUMPTION IS CURED 



159 



He cannot tax his stomach by eating things that are not 
nourishing; all the work his stomach can do must be 
devoted to the foods he really needs. 

The weapons with which we fight consumption are rest, 
good food, fresh air, and sunshine. These will do more 
good than all the medicine in the world. Fresh air is not 




Fig. 74. A window tent. (Invented by Dr. W. E. Walsh.) 



only one of the best things for the cure of consumption, but 
it is one of the best things for the prevention of consump- 
tion. You should always breathe plenty of fresh air night 
and day, and there is plenty of fresh air to be had if you 
will take it. 

If you have only a single window in your room, try to How to have 

fresh. 3.ir 3.t 

sleep w T ith your head in the fresh air. It is not always easy home: 

to arrange a room in such a way that you can have fresh 

air without placing your bed in a draft, but even this 

difficulty can be overcome. 

There are several devices, called window tents, which (/) B J Y in " 

dow tents 



i6o 



PRINCIPLES OF PUBLIC HEALTH 



{2) By sleep- Fig 
ing porches 



(3) By tent 
cots 



you can buy. By the use of such a tent, your head will 
be out-of-doors all the time; yet the draft cannot strike 
your body, because a part of the tent fits around your 
neck and cuts off the air from the rest of your body. One 
of these tents is shown in Figure 74. You do not put your 

head out of the window; your 
head is on your pillow just as 
if the tent were not there. 
Your bed is placed directly in 
front of the window and the tent 
comes down over your pillow, 
allowing your head practically 
to be out-of-doors, but keeping 
the cold air out of the room. 
Sleeping under a window tent 
is the next best thing to sleeping 
out-of-doors. 

Many of our modern houses 
are built with sleeping porches 
on which one can sleep out- 
doors summer and winter. Where there is not a special 
sleeping porch on the house, an ordinary porch may often 
be made to serve the purpose, or a very inexpensive sleep- 
ing porch can be added to the house. 

Sometimes people cannot get the use of a porch of 
any kind. In such cases it may be possible to put up 
a tent in the yard. If the yard is very small, a tent 
cot may be used. This is simply a cot with a tent on 
it, w T hich can be closed up and put away in the day- 
time and set up again at night. In a large city where 
the houses have no yards at all, this arrangement can 




75. A sleeping porch 
built in a house. 



HOW CONSUMPTION IS CURED 



161 



be used by setting it up on the roof of the house. There 
is almost always some way of securing fresh air at night 
if we will only give a little thought to the matter. 

Unfortunately, many of our school buildings are not Fresh air in 
provided with good ventilating plants. A proper system schoolrooms 




Fig. 76. An open-air schoolroom for consumptive children. 

of ventilation furnishes at least 1200 cubic feet of fresh air 
per hour for each child in each room. 

In large cities it is often impossible to find outdoor The necess- 
space in which boys and girls may play during recess, ^oimds^" 
Even this difficulty can be overcome by turning the roof 
of the school building into a playground, with a high wire 
netting around it. 

Every school yard should be provided with swings, bars, 
and gymnasium apparatus to encourage the children to take 
plenty of exercise. Children who live in crowded towns 



162 PRINCIPLES OF PUBLIC HEALTH 

need exercise during vacation as well as during school 
days, and the school yards should be open to them at all 
times. A summer teacher who shows the children the 
best way to exercise, has work fully as important as that of 
any other teacher during the school term. 

A sound body is more valuable than education itself, 
but a good education and a sound body together are the 
best assets any man or woman can have. 

Questions, i. State the four things necessary to cure con- 
sumption; show the value of each. 2. What is the value of 
fresh air to every one ? 3 . How may an abundance of fresh 
air be secured in the home? 4. In the school? 

Remember. 1. Rest, fresh air, sunshine, and nourishing 
food are the cures for consumption. 2. All these things can 
be secured in any climate and by every person. 3. Tubercu- 
losis is a communicable disease. 4. Tuberculosis can be 
prevented. 5. Tuberculosis can be cured. 



APPENDIX 1 



A SUMMARY OF ANATOMY 



BONES AND JOINTS 

The framework of the body is composed of bones. There 
are 206 bones (not including the teeth) in the body. The 
bones of the body are divided into four classes — long bones, 
short bones, flat bones, and irregular bones. 

Regardless of their shape, all bones are composed in the 
same way. Every bone has an outer and an inner portion. 
The outer portion is a dense layer called compact bone. The 
inner portion is more open, and is much weaker; this is 
called cancellated bone (from cancella, a sponge). In the 
smaller bones, the marrow, which is quite soft, runs through 
the spongy bone; in the larger long bones, the marrow is 
distinct and is enclosed by the spongy bone. 

Every bone is covered by a thick, tough layer, the peri- 
osteum, which has three uses. When the bone is injured by 
disease or accident, the periosteum makes new bone to fill 
in and repair the break. It also builds new bone on the sur- 
face of the old as long as the body is growing. Finally, the 
periosteum gives strong and firm attachment to the muscles, 
which send tendons into it. 

Every bone in the body (except the hyoid bone, to which 
the tongue is attached) is joined with some other bone. 
Most of them join with two or more bones. In most instances 
the end of a bone which joins with another is rounded off 
and made very smooth, so that it can slide easily over the 
other bone. There are three principal kinds of joints in the 
body. They are called the ball and socket joint, the hinge 
joint, and the serrated or saw-tooth joint. 

The ball and socket joint is one that can move freely in all 
directions. We see it illustrated in the joints of the shoulder 

1 At the request of many practical teachers the author has appended 
this brief summary of anatomy. The material is intended to be used 
for reference or to be assigned as lessons in connection with the chap- 
ters of the book, at the discretion of the teacher. 

163 



The frame- 
work of the 
body 



Construction 
of bones 



The perios- 
teum 



Joints 



The ball and 
socket joint 



1 64 



APPENDIX 



humerus 




Fig. 77. The skeleton. 



SUMMARY OF AX ATOMY 



165 



bard 
Wbone 



and hip. In these joints one of the bones has a deep depres- 
sion in it, and this depression forms the socket. The other 
bone has a rounded head that tits into the depression. We 
cartilage ca ^ tms rounded head the ball. 

The hinge joint is illustrated in The hinge 
the knee and elbow joints. These J0mt 
joints can move backward and 
forward in one plane like a hinge, 
but they cannot move in a circle 
like the ball and socket joints. 
You cannot swing your forearm 
about on a pivot at the elbow as 
cavity^ you can your whole arm, nor will 

the knee joint bend in every direc- 
tion as does the joint at the hip. 

periosteum Jftf Serrated joints do not move. The Serrated 

bones having serrated joints are J omts 
fitted tightly together so that they 
form practically one bone. We 
find this kind of joint illustrated 
in the way the bones of the skull 
are put together. 

The joints of the body are not Ligaments 
held together by rivets, pins or 
bolts as are the joints of a ma- 
chine, but by bands of very tough 
tissue placed about a joint in such a way as to allow it 
to move freely, although the bones are all the time 
held firmly together. These bands are called ligaments. 
Ligaments are much better than bolts or pegs would be, 
because they stretch a little, and thus prevent the breaking 
of the bones when the joint is put under a severe strain. 



spongy 

.00m 



cartilage* 

Fig. 78. The structure of a 
bone. 



1 66 



APPENDIX 




Fig. 79. The muscles. 



SUMMARY OF ANATOMY 



167 



MUSCLES AND TENDONS 



What muscle 
is 



How the 
muscles 
work 





The lean meat of any animal is composed entirely of 
muscle tissue. It is the function of the muscles to move 
the body 

The muscles are nearly all attached to the bones. They 
are just long enough to let the joint straighten out when 

the muscles are at rest, but 
when the joint bends the 
muscle contracts. When a 
muscle contracts it becomes 
shorter and thicker. . Some- 
times it becomes very much 
'/JL triceps thicker in one place. Every 
boy knows how much thicker 
the arm muscle (biceps) be- 
comes when he bends his 
elbow hard. He calls this 
"showing his muscle." 

There is not room enough Tendons 
on most of the bones for all 
the muscles to be attached directly to them. Instead of 
being thus attached directly to the bone, they end in what 
we call tendons. These tendons are hard and strong, and 
a very small tendon will lift as much without breaking as 
quite a large muscle. The muscles are soft and would have 
to be attached over a large area in order to secure the required 
strength. The tendons, being so much stronger than the 
muscles, can be attached to a very small area and yet secure 
the same amount of power as would result from attaching 
the muscle itself. 

The tendons pass directly into the periosteum, the thick, 
strong covering of the bones. So strong is this attachment 
that the bone will often break before the tendon will pull 
loose. 



Fig. 80. 



The biceps muscle 
contracted. 



1 68 



APPENDIX 



THE SKIN 



The skin as 
an armor 



Sweat 
glands 



mis 



hair 



The entire body is covered with skin, which regulates the 
heat of the body and acts as an armor against blows and cuts 
which would otherwise injure the delicate nerves and blood 
vessels beneath. It also serves to some extent to keep out 
the germs of disease. The skin 
appears to be smooth, but if you 
examine it through a strong 
magnifying glass you will see 
that it is divided into little 
areas. The dividing lines do 
not run straight, however, and 
the areas are not square like 
those you find on a checker- 
board. 

After looking at the skin with 
a strong magnifying glass you 
will think that you must have 
seen all its irregularities, but if 
you will look at it with a power- 
ful microscope you will find out 
many other things. In the first 
place you will see many little 
openings in the skin. These 
little openings make the ridges 
which divide the skin into little 
areas. Some of the openings are 
sweat glands, and there is always 
some perspiration coming out of them. When you are very 
warm you can see, without the aid of the glass, the drops of 
perspiration as they come out on the surface of the skin. 
When you are not very warm you cannot see these drops of 
perspiration, but they are nevertheless coming out all the 
time. When the perspiration comes so slowly that you 
cannot see it, it is called insensible perspiration. 




dermis sweat gland 

Fig. 8i. A section of the 
skin, highly magnified. 



SUMMARY OF ANATOMY 



169 



The whole body is covered with hair. You can see the Hair 
hair on your head and some of the hair on your arms and 
the backs of your hands, but most of the hair on the body 
is so fine that you cannot see it without a microscope. Each 
of the fine hairs on the body has a root that goes through 
the skin just as the root from each hair on your head goes 
through it. 

Opening into the little pockets in which the hairs stand, Sebaceous 
are glands that secrete a kind of oily material. They are glands 
called sebaceous glands or follicles. Sometimes these follicles 
become stopped up; then the material they secrete becomes 
thick and cheesy, and the little black points appear on the 
skin which we call blackheads. The white matter which 
comes out of these blackheads is merely the secretion of the 
glands from which the water has been absorbed, leaving the 
solid or cheesy portion. 

There is a part of the skin that we do not usually think of Nails 
as skin. We mean the nails. The finger nails and the toe 
nails do not look like the rest of the skin of the body, but 
they are made of just the same kind of cells. The cells of 
the nails are flat, dead, and closely packed together. There 
are no sweat glands, or sebaceous glands, or any hairs in 
the nails. 



THE DIGESTIVE SYSTEM 



The digestive system is the part of our bodies in which The ali- 
the food we eat is so changed that it can be made use of by ^Jl^ Ty 
the little cells in the body. It is composed of a long canal 
with many parts and enlargements, each part necessary for 
a certain required work. This canal as a whole is called the 
alimentary canal. 

The mouth does the first part of the work for the diges- Teeth 
tive system. Here we find the teeth, which are used for 
grinding the food. The teeth are composed of three parts, 
the head (or crown), the neck and the root. The head, or 



170 



APPENDIX 



The salivary 
glands 



The 
esophagus 



esothagus- 



crown, is very hard. Each tooth is hollow, and in the hollow 
portion there are nerves and blood vessels. 

Opening into the mouth are three pairs of glands known 
as salivary glands. One pair of glands is located just above 
the angle of the jaw. It 
is these glands that be- 
come swollen when we 
have mumps. Another 
pair of glands is placed 
just inside the jaw bone, 
near the root of the 
tongue, and the third 
pair is located under the 
tongue. These three 
pairs of glands secrete the 
saliva which moistens 
the food and aids in 
digesting the starch. 

The food passes from 
the mouth, through a 
passage called the esoph- 
agus, or gullet, to the 
stomach. 



small 
intestine 

large 
intestine 




stomach 



Fig. 82. The alimentary canal. 



The stomach The stomach is one of the enlarged parts of the alimentary 
canal. Its walls are quite thick, and in these walls are thou- 
sands of little glands. These glands secrete a fluid called 
gastric juice. When the food enters the stomach it is held 
there for a long time, and the walls of the stomach squeeze 
upon it so that the food is mixed with the gastric juice until 
every bit of it that will be of any use to the body has become 
fluid in character. Not only does the gastric juice make the 
food liquid, but it acts on it and changes some of it so that 
it will be suitable for use by the little cells of the body. As 
* fast as the food is made liquid by the juices of the stomach 
it is allowed to pass into the intestine through an opening 
called the pyloric opening. 



SUMMARY OF ANATOMY 



171 



The intestine is a long, narrow, twisting and turning tube The 
that is divided into two principal parts, the large and small intestme 
intestine. In the walls of the intestine are many little glands 
that secrete a fluid that helps in digesting the food. Two 
fluids, one made by the liver, the other by the pancreas, are 
brought into the intestine by two small tubes, which come 
together in the wall of the intestine six or seven inches below 
the pyloric opening. These fluids perform a very important 
part in the digestion of all the different foodstuffs. 

Besides the little glands in the walls of the intestine there Villi and 
are many thousands of little finger-like projections standing ymp a cs 
up from the walls. These are called villi. Each villus has 
in it very small vessels, into w T hich the food passes after it 
has been digested. These vessels are of two sorts: blood 
vessels, which take up the digested starch and proteid 
foods, and another sort known as lymphatics, which take 
up the fats. All the lymphatics combine into a single 
vessel which empties into the great vein at the base of 
the neck. Thus the fatty foods pass into the blood and are 
mingled with the food materials taken up directly by the 
blood vessels. 



CIRCULATION OF THE BLOOD 



There are two kinds of blood vessels in the body. We 
call them arteries and veins. The arteries serve to carry the 
blood from the heart to all parts of the body, and the veins 
serve to carry the blood back to the heart. The heart is 
really a part of the blood vessels, half of each side being like 
the veins and half like thenar teries. 

The w T alls of the arteries are thicker than those of the 
veins. Two sets of arteries leave the heart, one from each 
side. The artery that starts from the right side of the heart 
goes to the lungs and carries venous blood, w r hich has a very 
poor supply of oxygen and is full of impurities. We call this 



Two kinds 
of blood 
vessels 



Arteries 
and veins 



1/2 



APPENDIX 



Capillaries 



Changes in 
the blood 



Venous 
blood 



the pulmonary artery. The artery that leaves the left side 
of the heart goes to all parts of the body but the lungs and 
carries arterial blood, which has much more oxygen and is 
much more free f om impurities. 

If we follow the blood as it circulates we will see how it 
reaches all parts of the body. The big artery that leaves the 
left side of the heart divides into smaller and smaller arteries 
until there are branches going to every part of the body. 
These branches keep dividing until they are so small that 
we call them arterioles, and these little arterioles again divide 
and become so small that we call them capillaries. 

While the blood is passing through the arterioles and the 
capillaries, something is happening to it. The little cells 
with which these small vessels come in contact have been 
taking the oxygen and the nourishing material out of the 
blood. At the same time they have been putting something 
into the blood. In place of the oxygen they have been putting 
in carbon dioxid and in place of the nourishing material they 
have been putting in the worn-out materials from the cells. 
As the blood passes through certain parts of the body, such 
as the kidneys, the worn-out materials from the cells are 
taken out of the blood and sent out of the body. The carbon 
dioxid is left in the blood until it goes to the lungs. 

The blood has now been followed to the capillaries, where 
oxygen and nourishing material have been taken out of it, 
and where something else has been added to it. As we follow 
a little capillary, we find that instead of dividing again, it 
joins others and gradually grows larger. As these blood 
vessels grow larger the walls do not become so thick as the 
walls of the arteries of the same size. These larger vessels 
formed by the union of capillaries are called veins. In other 
words, the veins are simply continuations of the arteries 
that have divided into extremely small branches and have 
now come together again. The blood which has been changed 
is now called venous blood. It has much less oxygen in it, 
but has received a great deal of carbon dioxid. The veins 



SUMMARY OF ANATOMY 



173 



CAPILLARIES OF 
CHEST AND ARMS 



PULMONARY ARTERY S 



RIGHT LUNG 



CAPILLARIES OF 

STOMACH, INTESTINE 

AND SPLEEN 



CAPILLARIES 
OF HEAD 



LEFT LUNG 




CAPILLARIES 
OF LECS 



Fig. 83. The white vessels represent the circulation of the arterial 
blood; the gray, the circulation of the venous blood. 



174 



APPENDIX 



Arterial 
blood 



Entire 
circulation 



Use of the 
respiratory 
system 



The use of 
the nose in 
breathing 



continue to come together, until finally they form a single 
large vein which empties into the upper half of the right 
side of the heart. From there the blood is driven into the 
lower half of the right side of the heart and thence to the 
pulmonary artery, which goes to the lungs. The blood is 
not changed in the heart, so what goes into the pulmonary 
artery is still venous blood. 

The blood goes straight from the heart to the lungs and 
there it is changed into arterial blood. The change consists 
in taking oxygen from the air and giving off carbon dioxid 
to the air. From the lungs the blocd goes through the capil- 
laries again into the veins, the small capillaries in the lungs 
uniting to form the pulmonary veins. These veins finally 
unite into one vein that empties into the upper half of the 
left side of the heart, and from there the blood goes to the 
lower half of the same side. The blood has now reached its 
starting point and is ready to begin its journey again. The 
journey of the blood is as follows: 

From the right side of the heart to the arteries; from 
arteries into arterioles; from arterioles to capillaries; from 
capillaries into veins; from veins into the heart; from the 
heart to the lungs; and from the lungs back to the heart 
again. 

THE RESPIRATORY SYSTEM 

That portion of the body by which we breathe is called 
the respiratory system. This system is composed of the 
nasal passage, the pharynx, the larynx, the trachea, the bronchi, 
and^the lungs. The mouth is not a part of the respiratory 
system; we should never breathe through our mouths. 

As the air passes through the nasal passage it is warmed 
and moistened, and a great deal of dust and dirt is taken out 
of it. Thus the nasal passage serves to warm, to moisten, 
and to clean the air we breathe, and is a very important part 
of the respiratory system, since either cold or dry air is very 
irritating to the lungs. 



SUMMARY OF ANATOMY 



175 



opening 
of tube 
from 
the ear 



There is only one tube leading from the back of the nasal Pharynx, 
passage to the lungs. Different parts of this tube are given J* 17 ?*' and 
different names.' The pharynx is that part that extends 

from the back of the nose 
to the vocal chords. The 
larynx is the part of the 
throat where the vocal 
chords are located. We 
sometimes call it the " Ad- 
am's apple." It is very 
prominent in some men, 
but seldom noticeable in 
women. The trachea is 
the part of the tube lead- 
ing down from the larynx. 
At the lower end of the 
trachea the tube divides 
into two parts that we 
call the bronchi, one lead- 
ing to each lung. 

The bronchi carry the The bronchi 
air from the trachea to 
the lungs. They divide 
again and again until they 
become so small that 
there is a branch for each 
little air cell in the lungs. 

The lungs are the most important part of the respiratory The lungs 
system. They are made up of lobes. There are two lobes 
in the left lung and three in the right. Each lobe is tftvided 
into lobules, which means small lobes. Each lobule is divided 
into air spaces. In these air spaces, or cells, the work of the 
lungs is performed. 

The capillaries run in the thin walls of the air spaces. Air cells 
The walls of these fine blood vessels are so very thin that 
the air in the air cells comes in almost direct contact with the 




Fig. 84, 



The air passages 
head and throat. 



176 



APPENDIX 



blood in the vessels. While the blood is passing through the 
vessels in the walls of the air spaces, something happens to 
both the blood and the air. The air we take into our lungs 



larnyx 




m% 









Fig. 85. The lungs. 



Necessity of 
pure air 



contains a great deal of oxygen and very little carbon dioxid. 
The air that comes out of our lungs contains a great deal of 
carbon dioxid and much less oxygen. In other words, the 
oxygen from the air goes into the blood, and the carbon 
dioxid from the blood goes out into the air. 

If the air we breathe is not pure and does not contain 



SUMMARY OF ANATOMY \/7 

enough oxygen, the blood cannot get all the oxygen we need, 
and the cells of the body become sick and die. If, when we 
breathe, we do not till each little air cell in our lungs with 
air, a great deal of the blood sent to the lungs for oxygen 
cannot get it. If we wear very tight clothing we cannot take 
a full breath and hence cannot fill all the air spaces with air. 
If the air spaces in the lungs are not filled, the blood does not 
get the oxygen it needs, as there is no other place in the body 



to get it. 



THE EYE AND THE EAR 

The eye is one of the most important organs in the body The eye 
and also one of the most delicate. It is very much like a ^'acSnem 
camera. 

When you look at an eye you are likely to think that the The cornea 
front of it is blue or brown. The colored part is not the front g^^ 
of the eye. If you look at the eye from the side you will 
see that there is a curved part in front of the colored part 
and that the curved part is perfectly clear. This curved 
clear part of the eye we call the cornea. The cornea connects 
w T ith the white part of the eye, and this white part extends 
all around the rest of the eye, except at a small point in the 
back where the optic nerve comes through. This white part 
we call the sclera. 

The space between the cornea and the colored part of the Aqueous 
eye is filled with a clear fluid that is called the aqueous humor, numor 
which means watery fluid. The space occupied by this fluid 
is called the anterior chamber of the eye. 

The iris, which is the colored portion of the eye, is a cur- The iris 
tain that is hung between the anterior and posterior chambers 
of the eye. It prevents any light getting into the posterior 
chamber except that which passes through a round hole in 
the iris called the pupil. The pupil grows larger or smaller 
according to the amount of light needed by the eye. If you 
look away from a bright light at something in the dark, the 



1 7 8 



APPENDIX 



Lens 



Vitreous 
humor 



The retina 
and the optic 
nerve 



Movements 
of the eye 



nerve 



pupil grows larger; if you look back at the light, it grows 
smaller. You can see this in a hand mirror. 

Behind the pupil is a clear mass shaped like a very strong 
magnifying glass. This is the lens. The lens causes to be 
formed on the back of the eye a clear picture of whatever 
you are looking at. When you focus a camera, you move 
the back towards or away from the lens. When you focus 
your eye you cannot move the back of the eye, but you can 
make the lens more or less 
convex as may be needed to 
make a clear picture. 

Behind the iris and the 
lens, we find the posterior 
chamber of the eye. This 
occupies by far the greater 
portion of the ball and cor- 
responds to the dark cham- 
ber of a camera. This 
chamber is rilled with a 
clear fluid called the vit- Fig. 86. A cross-section of the eye. 
reous humor, which means 
jelly-like fluid. It is a clear, gelatinous substance. 

The optic nerve enters the eyeball from the back and 
spreads its fibers out in a thin membrane called the retina, 
which corresponds to the sensitive plate in a camera. The 
lens focuses on the retina the image of any object you look 
at. The impression made on the minute nerve endings in 
the retina is carried by the optic nerve fibers to the brain. 
When this impression reaches the brain we see the object. 

Each eye has six muscles that turn it in whatever direction 
you want to look. These muscles are very delicate, and for 
true sight they must be exactly adjusted. If the muscles on 
one side of the eye are stronger than those on the other side, 
you will be cross-eyed or wall-eyed. If one of the muscles in 
one eye is stronger than the corresponding muscle in the other 
eye, it pulls the eyeball out of place and you "see double." 




SUMMARY OF ANATOMY 



179 



The portion of the ear that you see on the side of your 
head has as much to do with hearing as the outer rim of 
the horn into which you speak has to do with making a 
record for the phonograph. You know that the record is 
really made at the little end of the horn, while the big end 



The use of 
the outer ear 



inner ear 




middle ear 

Eustachian tube 

Fig. 87. The ear, showing the outer, middle, and the inner part. 



simply collects the sound. The outside portion of the ear 
simply collects sounds, and the real hearing is done with the 
portion of the ear that is not seen. 

The outer ear connects with the short tube that leads to 
the drum, which is a thin membrane that separates the 
middle ear from the outer ear. This drum does not have 
so much to do with hearing as is supposed. To have a hole 
in the drum does not mean that you cannot hear. 

The middle ear is that portion which is just inside the The middle 
drum. In this we find a chain of little bones. The one ear 
attached to the drum is shaped much like a hammer, and 



i8o 



APPENDIX 



spinal cord 



nerves 




Fig. 88. The nervous system. 



SUMMARY OF ANATOMY 



181 



is called the malleus, which means mallet or hammer. The 
next one is shaped like an anvil and is called incus, which 
means anvil, and the third is called stapes, which means 
stirrup. The flat part of the stapes fits into a small open- 
ing that leads to the internal ear. 

The internal ear is shaped like a snail shell. It makes 
several turns, which are hollow like the ends of a conch shell. 
In these channels the nerve that receives the impressions 
made by the sounds is distributed. This nerve carries the 
impressions to the brain. 



The inner 
ear 



THE NERVOUS SYSTEM 

This system is so important in its use and so difficult to 
understand in its details, that a description of it should have 
more space than can be given in this summary. Can you 
imagine having no feeling and being unable to move ? This 
would be your condition if you had no nerves. 

Briefly, the nerves might be called the telegraph system of 
the body. There is a great central station called the brain 
where messages are received and sent out; there are many 
sub-stations that make up the spinal cord. Twelve great 
nerves pass directly from the brain to the body; all others 
pass from the spinal cord. 

Every nerve leaving these centres divides and sub-divides 
into little threads as the arteries divide and sub-divide into 
arterioles and capillaries, until every part of the body — every 
muscle and part of the skin — has its nerve. 

Every time you choose to move your hand, your brain sends 
to the necessary muscles an instantaneous order to act. This 
is called voluntary action. If you put your finger against a hot 
stove you jerk it away before you could have time to choose 
to do it. This happens as an order from a sub-station and 
is called reflex action. 

Messages travel both ways and it is necessary that the ner- 
vous connection with every part of the body remain unbroken, 
and important that the nervous condition be kept healthy. 



Importance 
of the 
nervous 
system 



Nerves com- 
pared to 
telegraph 
system 



Extent of 

nervous 

system 



Voluntary 
and reflex 
action 



1 82 APPENDIX 



NOTES TO THE TEACHER 

A false delicacy has often prevented the teaching of vital 
lessons to growing children. The day is now at hand when 
foolish sentiment must no longer prevent the spread of any 
knowledge which is necessary to exterminate the plagues 
that have afflicted the race. 

In chapters 17, 18, 19 and 32, unpleasant facts are given 
in plain language. They are facts that parents do not 
teach their children and that most teachers will not frankly 
treat with classes in a school. Though they are disagree- 
able to discuss, they are essential for children of school 
age to know. Now that the dependence of public health 
upon personal hygiene is recognized, personal habits and 
sanitary conditions are more frankly dealt with than 
formerly. 

It is an excellent thing occasionally, to have one or two 
points of an assigned lesson answered in writing. Any 
topic that the teacher may think advisable to treat in this 
manner may be discussed on paper at the beginning of 
the recitation, five or six minutes being allowed for that 
purpose. Even a whole chapter may be assigned to be 
studied with a view of answering in writing the questions at 
the end of the chapter. The written test can then take the 
place of the usual oral recitation. This method is sug- 
gested to the teacher who hesitates to discuss orally certain 
plain but essential facts. 

Chapter 32 on the Spread and Prevention of Consump- 
tion can be treated with best results orally, if the pupils are 
first made to feel the great danger of consumption and to 
realize the possibility of preventing the vast havoc wrought 
by that dread disease. The attitude of teacher and pupils 
should be that while the discussion may be disagreeable, the 
disgusting habits referred to in the text are so commonly 
practised that unless their dangers are taught this disease 
can never be wiped out. 



INDEX 



Adenoids, 49, 50 

Air, amount necessary for health, 
45; effects of impure, 45-48; 
fresh air, when needed, 45-48; 
how secured, 46, 47; how 
changed in body, 45; necessity 
of pure air, 45-48 

Air cells, 175 

Alcohol, effect of, on body, 67-70; 
on brain work, 70; on consump- 
tives, 69; on descendants, 69; 
on liver, 68; on morals, 69; on 
nervous system, 69; on powers 
of resistance, 68; on stomach, 
67; false ideas about effects of, 
67; what business men think 
of, 70 

Alimentary canal, 169, 170 

Amoebic dysentery, how pre- 
vented, 122; how spread, 122; 
where prevalent, 122 

Animals free from typhoid fever, 

113 

Antitoxin, how it acts, 108-110; 
how discovered, 109; some- 
times considered a poison, in; 
prevents diphtheria, no; saves 
lives, no 

Aqueous humor, 177 

Arterial blood, 172 

Arteries, 171 

Articles used by the sick, dangers 
from, 75; how to treat, 76 

Bathing, importance of, 60; fre- 
quency of, 60 

Baths, hot, 61; cold, 61 

Bedtime for children, 51 

Blood, arterial, 172; how changed 
in the body, 1 74 ; venous, 171,172 

Boils, how caused, 95, 99 

Bones, 163 

Bronchi, 175 

Building foods, 14, 15 



183 



Candy, When harmful, 54; when 
not harmful, 54 

Canned meats, why poisonous, 32 

Capillaries, 172 

Cells, are alive, 6; body made of, 
6; body needs new, 14; how 
killed, 7; must not be killed, 
6; size of a, 5; what they are 
like, 5 

Circulation of the blood, 1 71-174 

Clothing, effect of damp, n; pro- 
motes health, 9; proper weight 
of, 10 

Common drinking cup, 153 

Consumption. See Tuberculosis 

Cooking, effects of improper, 34, 
35; fatty foods, 34; meats, 35; 
starchy foods, 34 

Cornea, 177 

Coughing, dangers from, 147, 150- 
153; how to prevent dangers 
from, 152, 153 

Cuspidors, in public buildings, 152; 
pocket, 152; street, 152 

Dairy, sickness about a, 26, 103, 

115 

Decomposed foods dangerous, 30, 
32 

Decomposition, cause of, 30; effect 
of cold on, 31; of foods, 30-32 

Desserts, when harmful, 40; when 
not harmful, 40 

Dining table, effect of dirty, 37; 
cheerfulness at, 37 

Diphtheria, cure of, 108-111, 
germs present after recovery, 
1 01, 102; germs present when 
throat is not sore, 104; how to 
confine germs, 100; how poison 
is fought, 108-110; mild cases, 
how detected, 104; nature of the 
poison, 108; prevalence of, 100; 
where germs come from, 100; 



1 84 



INDEX 



why some cases are not quaran- 
tined, 102-104 

Dirt, a cause of sickness, 77, 78; 
getting into milk from cows, 23, 
117; from cow barns, 23-25; 
from milk cans and bottles, 26, 
27; from milkmen, 25; from 
flies, 28, 80, 81 

Diseased animals, effect on meats, 
19-21; effect on milk, 28; tuber- 
culosis from, 28, 155 

Drafts, evil effects of, 10; how to 
prevent harm from, 10 

Ear, care of, 58; drum, 170; inner 
ear, 181; middle ear, 179; outer 
ear, 179 

Esophagus, 170 

Excreta from sick, how dispose of, 
76, 118 

Exercise, necessity of, 51, 161 

Eye, how germs get into, 56; how 
overworked, 5 7 ; method of test- 
ing, 58 

Far sight, 58 

Flies, breeding places for, 77, 80; 
as germ carriers, 80, 81, 116; 
how to get rid of, 82, 83; how to 
keep out, 83 

Fly screens, where needed, 83 

Foods, advertised, 16; building, 
14-16; decomposition of, 30-32; 
heat producing, 14-16; im- 
proper cooking of, 34, 35; cost 
of suitable, 16; uses of foods, 
14-17; uses of starches, 14; 
uses of fats, 15; value of meat 
as a, 15; value of milk as a, 14 

Garbage cans, should be covered, 

Germs, cause of poison in meats, 
31, 32; carried by dogs and cats, 



106; effect of, in wounds, 95-99, 
how, get through the skin, 95; 
how, get into the body, 79; 
how, get into foods, 79, 80; how 
put into the air, 147, 150; how 
kept out of the air, 151, 152; 
how to fight, 74; of lockjaw, 
98; man's greatest foe, 1. na- 
ture of a, 73; not alike, 73; not 
killed by running water, 115 

Hair, 169 

Hearing, how tested, 58 

Heat, how kept up in the body, 14 

Hookworm disease, character of 
the worm, 120; how it enters 
the body, 121; how prevented, 
122; nature of the disease, 121; 
where worm lives in the body, 
121; where prevalent, 122 

Insects that carry disease, 92-94 
Intestines, 171 
Iris, 177 

Joints, 163 

Larynx, 174, 175 
Lens, the, 178 
Ligaments, 165 
Lungs, 175 
Lymphatics, 171 

Malaria, how transmitted, 92; 
how prevented, 93 

Manure, a hatching place for flies, 
80, 82; how to dispose of, 82 

Meal times, frequency of, 53; reg- 
ularity of, 53; should be pleas- 
ant, 37, 38 

Measles, after effects of, 128; fatal- 
ity of, 128; necessity of care in, 
129; seriousness of, 128; why to 
avoid, 128 



INDEX 



[85 



Meats, characteristics of good, 18; 
Clean Meat League, .19; from 
diseased animals, 19-21; germs 
cause poison in, 19, 32; how 
kept clean, 18; should be cooked, 
35; value of, as a food, 18 

Milk, as carrier of disease, 22, 117; 
effect of germs on, 22; effect of 
disease in cow on, 28; flies in, 28; 
how germs get into, 23-28; im- 
pure, dangerous, 22; polluted 
water in, 27; typhoid fever car- 
ried by, 117; value of, as a food, 
14, 20 

Mosquitoes, as disease carriers, 92, 
93 ; how to get rid of, 94 

Mouth, why some breathe through, 

49 
Mouth breathing, effect of, 50 
Muscles, attachment of, 167 

Nails, how to care for, 61, 62 

Near sight, 57 

Nerves, compared to telegraph 

system, 181; distribution of, 181 
Nose, importance of breathing 

through, 48 

Overcoats, necessity of, 12 
Overwork, effect of, 51, 52 

Paper napkins for consumptives, 

152 
Parties, time for, 53 
Pencils in mouth, 155 
Pharynx, 175 
Play a form of work, 52 
Playgrounds, 161 
Pocket cuspidors, 152 
Ptomaines, 19 

Quarantine, breaking, shows self- 
ishness, 126; how broken by 
family, 105; rules of, 105; se- 



riousness of breaking, 101; when 
safe to raise, 102; why necessary, 
101; why some cases escape, 
102-104 

Reflex action, 181 
Respiratory system, 174-177 
Rest, proper amount of, 51 
Retina, 178 
Rocky Mountain Spotted (Tick) 

Fever, how transmitted, 94 
Rubbers, necessity of wearing, 1 1 

Saliva, effect of, on starches, 39, 

41 
Salivary glands, 170 
Scarlet fever, a dangerous disease, 

124; mild cases dangerous, 123, 

124 
Scarlatina, 125 
Scarlet rash, why quarantine is 

necessary in, 125 
School lunches, 37 
Sclera, 177 

Sebaceous glands, 169 
Sewage, effect of, on water, 85-87, 

115 

Sickness about a dairy, 26, 103, 
115; due to germs, how pre- 
vented, 3 

Sick room, stay away from, 75 

Skin, care of, 60, 61 

Smallpox, fatality of, 131; how 
prevented, 135-137; during 
Franco-Prussian War, 132; in 
Sweden, 133; in Gloucester, 134; 
in the Philippine Islands, 134 

Spitting, dangers from, 151; how 
avoided, 152; where to spit, 152, 
153; where not to spit, 151 

Springs, how polluted, 87 

Street cuspidors, 152 

Sunshine, effect of, on germs, 77, 

78 



1 86 



INDEX 



Suppuration, how the surgeon pre- 
vents, 96; how you may prevent, 
97; real cause of, 96 

Sweat glands, the work of, 60 

Teeth, brittle, 42; dangers from 
poor, 41-43; how to care for, 43; 
necessity of baby teeth, 41; 
uses of teeth, 41 ; why, decay, 42 

Tendons, 167 

Tobacco, a poison, 64; effect of, on 
blood, 65; on heart, 66; on ner- 
vous system, 66; on nose and 
throat, 65; on stomach, 66; 
extra work caused by, 64 

Toilets, improper construction of, 
86; proper construction of, 87; 
relation to wells, 85-87 

Tonsils, 49, 50 

Trachea, 175 

Tuberculin test, 155, 156 

Tuberculosis, can be prevented, 
142, 148, 157; fatality of, 142; 
fresh air in, 157, 158; germ, dis- 
covery of the, 145; how to get, 
out of a house, 147, 148; how 
germs leave the body, 150, 151; 
how spread from cows, 28, 155; 
how spread from the lips, 153- 
155; how detected in cows, 1 5 5 ; a 
house disease, 146, 147; not in- 
herited, 146; of the glands, 144; 
of the joints, 143; of the spine, 
144; of the stomach, 144; of the 
throat, 143; prevalence of, 142; 
pure food in, 158; rest in, 157; 
should be recognized early, 157; 
sunshine in, 158; why called the 
Great White Plague, 142 

Typhoid fever, animals f ee from, 
113; carried by flies, 80, 81, 116; 
carried by milk, 22, 117; effect 



of a single case, 114; how germs 
leave the body, 113; how germs 
get into the body, 113; how 
germs get into water, 114; im- 
portance of cleanliness, 117, 118; 
life of germs in a stream, 115; 
recovered patient dangerous, 117 

Umbrellas, necessity of, 11 

Vaccination, cause of sore arms 
after, 140, 141; discovery of, 
132; how, prevents smallpox, 
135; necessity of repeating, 137; 
pretended vaccination, 138; 
when successful, 138 

Ventilation, in homes, 46, 159; in 
public buildings, 48, 161; in 
workshops, 48 

Veins, 171 

Venous blood, 171, 172 

vim, 171 

Vitreous humor, 178 
Voluntary action, 181 

Water, avoid polluting, 85-88, 
115; effect of sewage on, 85, 115; 
how germs get into, 85-88; pol- 
luted, in milk, 27; safe sources 
of, 88 

Wells, how polluted, 86, 87; rela- 
tion of toilets to, 86, 87 

Windows, should be kept open, 
45-47; should be screened, 83 

Wood-ticks, as disease carriers, 93 ; 
how abolished, 94 

Wounds, importance of keeping 
clean, 97 

Yards should be clean, 77 
Yellow fever, how transmitted, 92; 
how prevented, 92 









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